Adherence to Multiple Cancer Screening Tests among Appalachian Women

Appalachian populations suffer from higher rates of cancer incidence and mortality than non-Appalachian populations. Research has documented disparities in the receipt of within guideline cancer screening tests for each test individually (mammography (MA), Pap Test (PT) and colonoscopy, flexible sigmoidoscopy or FOBT (CRC)), however, no study has documented disparities in the receipt of multiple screening tests in this population. Methods. As part of a larger study using community-based participatory research strategies to reach Appalachian community members about the need for CRC screening, we surveyed 643 women aged 51–75, inclusive who agreed to complete a phone survey after being randomly selected from commercially available address lists for 12 Appalachian Ohio counties. The survey included questions about the receipt of screening tests within guidelines: PT (within 3 years), MA (within the past year), and CRC (FOBT: past year; FS: last 5 years; or colonoscopy: last 10 years). The frequencies of each test received within guidelines as well as the number of tests (0, 1, 2, 3) women were adherent to, were calculated. Odds ratios and 95% confidence intervals for being within guidelines were calculated using multiple logistic regression (performed for within guidelines for each test and for all 3 tests vs. 0–2 tests). Results. Women not screened within guidelines by self-report were 33% for PT, 46% for MA, and 48% for CRC. Only 31% of the women were within guidelines for all 3 tests, with 18% reporting not being within guidelines for any of the 3 tests. Predictors of within screening guidelines for all three tests include having a check-up in the past two years (OR = 14.7; 1.94, 111.5; p < 0.01) and not being a current or former smoker (OR = 0.28; 0.11,0.72; p < 0.01 and OR = 0.48; 0.25,0.93; p < 0.01, respectively). Conclusions. Few women in Appalachia Ohio are adherent to currently recommended cancer screening tests. Only about a third of the women were adherent to all three screening tests and almost a fifth of the women were not adherent to any of the three screening tests. These findings suggest that interventions should focus on improving multiple screening behaviors to reduce the high cancer rates in this underserved population.