Rectifying cancer disparities in rural Appalachia

Objective: This abstract is being submitted for consideration for inclusion in the Special Sessions on Rural Health Disparities. The purpose of this presentation is: 1) Demonstrate rural disparities in screening for cervical and colorectal cancers, and 2) Provide examples of potential interventions to rectify each disparity.

Methods: BRFSS data for Kentucky were analyzed. Weighted percentages of screening rates were calculated and logistic regression analyses were performed. Subsequently, data from an intervention study being conducted in rural Appalachian Kentucky and pilot data from a study of FIT testing were analyzed.

Results: Overall, Pap testing in Kentucky has declined in the past 10 years. However, women in urban areas were 35% (P<.001) more likely to have a Pap test in the past three years compared to rural women. Similarly, women in non-Appalachia areas had a 48% (P<.001) increase compared to Appalachian. Also, people 50 or older in urban or non-Appalachia had a 41% increase in the odds of having ever having a sigmoidoscopy/colonoscopy compared to those in rural and/or Appalachia areas. Our Prevention Research Center conducted non-clinic based screening for HPV among rural Appalachian women overdue for Pap tests and found that about one-third tested positive for at least one oncogenic HPV strain; related navigation services were effective. Our PRC is also planning an acceptability trial of FIT testing for the early detection of colorectal cancers in this population.

Conclusion: Rural populations residing in Appalachian Kentucky have a disproportionate risk of cervical and colorectal cancer, requiring innovative outreach and screening methods.