title: Effect of rurality on screening for breast cancer: a systematic review and meta-analysis comparing mammography.
abstract: BACKGROUND
  The lower breast cancer survival rate observed among rural women may be related to differences in screening access and utilization. We evaluated existing evidence for rural and urban differences in mammography service use in adult women.
  
  
  METHODS
  A systematic search was conducted on 4 April 2012 and updated on 1 November 2012, which yielded 28 studies for inclusion.
  
  
  RESULTS
  The rural population was less likely to have mammographic breast screening, and this difference was consistent in various areas of the USA as well as across a number of other countries. Meta-analyses using random effects models showed that women residing in rural areas were less likely than urban women to have ever had a mammogram (odds ratio (OR)=0.74, 95% confidence interval (CI)=0.62-0.89) or to have an up-to-date mammogram (OR=0.59, 95%CI=0.49-0.70).
  
  
  CONCLUSIONS
  Mammography is currently the best tool for the early detection and diagnosis of breast cancer. The rural disadvantage this review has identified may contribute to the lower breast cancer survival among women living outside urban areas.
authors: School of Population Health, University of Queensland, Brisbane, Queensland, Australia. j.leung1@uq.edu.au.
authors: J
authors: J
authors: Leung
authors: School of Population Health, University of Queensland, Brisbane, Queensland, Australia. s.mckenzie5@uq.edu.au.
authors: S
authors: S
authors: McKenzie
authors: School of Medicine, University of Queensland, Brisbane, Queensland, Australia. j.martin4@uq.edu.au.
authors: J
authors: J
authors: Martin
authors: School of Population Health, University of Queensland, Brisbane, Queensland, Australia. d.mclaughlin@uq.edu.au.
authors: D
authors: D
authors: McLaughlin
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000517:prevention & control*; D055088:Early Detection of Cancer / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008327:Mammography / Q000706:statistics & numerical data*; D008875:Middle Aged; D012424:Rural Population / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D014505:Urban Population / Q000706:statistics & numerical data; D016387:Women's Health