Cancer Screening Patterns Leave Women in Appalachian Kentucky Vulnerable

A study carried out in six rural counties in Appalachian Kentucky found a number of barriers linked to a lack of breast and cervical cancer screenings.

Published in the journal Women & Health, the study included in-person interviews with 222 women in which their adherence to cancer screening guidelines was assessed. The researchers found that while 33 percent had recently been screened for both, 48 percent rarely or had never been screened for both types of cancer.

According to the American Cancer Society, yearly mammograms are recommended for women age 40 or older. Clinical breast exams should be performed every 3 years for women in their 20s and 30s and every year for women 40 and above. When it comes to ovarian cancer, the ACS recommends that women between 21-29 years old receive a Pap test every three years, women between 30-60 years old every five years, and women over 65 who have had been regularly screened in the past with normal results should not be screened. Women at high risk, including those with HIV or an organ transplant, may need to be screened more often.

The new study, led by researchers from the University of Kentucky, identified four variables associated with increased odds of never or rarely receiving screenings for either disease. These included feeling that a Pap test is embarrassing, thinking that a lack of health insurance makes obtaining a Pap test difficult, a belief that breast cancer screening is unnecessary in the absence of symptoms, and reporting no physician recommendation of a mammogram in the last year.

These hesitancies are reflected in the fact that the overall cancer mortality rate in Appalachian Kentucky is 17 percent higher than the national rate. Incidence and mortality rates of invasive cervical cancer in the area are 67 percent and 33 percent higher than the national average, respectively.

Moreover, the belief that breast cancer screening is unneeded so long as no symptoms are present is worrisome, the researchers note, since often by the time a lump appears, the cancer is in a more advanced stage.

"Our study findings reinforce the challenges to screening faced by many vulnerable and underserved women," said Nancy Schoenberg, lead author on the paper and professor of Behavioral Science at the UK College of Medicine. "Whether they experience inadequate knowledge, as shown in this research, or inadequate resources, as shown in other studies, many women find it difficult to obtain optimal preventive health care. Facilitating optimal prevention will reduce the huge toll cancer takes on women, their families and their communities."