Trends in cervical and breast cancer screening practices among women in rural and urban areas of the United States

J Public Health Manag Pract. May-Jun 2009;15(3):200-9. doi: 10.1097/PHH.0b013e3181a117da.


Objective: The objective of this study was to assess rural-urban differences in mammography and Papanicolaou (Pap) smear screening.

Methods: Data from the Behavioral Risk Factor Surveillance System (1994-2000, 2002, 2004) were used to examine trends in these two tests by rural-urban residence location.

Results: In 2004, 70.8 percent of rural and 75.7 percent of urban respondents had received timely mammography; this difference remained significant in adjusted analyses and was greatest for women in remote rural locations. Although overall participation in mammography increased over time, a persistent rural-urban gap was identified. In contrast, in 2004, while 83.1 percent of rural and 86.1 percent of urban respondents had received a timely Pap test, the adjusted difference was not significant and Pap testing did not improve over time. Advanced age and low socioeconomic status were associated with a lack of screening.

Conclusions: Over an 11-year interval, mammography screening improved nationally, but women living in rural locations remained less likely than their urban counterparts to receive this test. However, no secular improvement in Pap testing was found, and no significant rural-urban differences were observed.

Policy implications: Interventions to improve breast cancer screening are needed for rural women. Such efforts should target older women and those with low socioeconomic status.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Behavioral Risk Factor Surveillance System
  • Breast Neoplasms / diagnosis*
  • Female
  • Humans
  • Mass Screening / statistics & numerical data*
  • Mass Screening / trends
  • Middle Aged
  • Practice Patterns, Physicians' / trends*
  • Rural Population*
  • United States
  • Urban Population*
  • Uterine Cervical Neoplasms / diagnosis*
  • Young Adult