"Abstract

Background: Breast cancer, the second most commonly diagnosed and second leading cause of cancer death among US women, is detected by screening methods including mammograms, breast MRIs, and genetic testing. There are known disparities in rural cancer care, including observed disparities in breast cancer screening. The COVID-19 pandemic worsened the rural cancer gap overall. This study aims to estimate the prevalence of various breast cancer screening methods among rural and urban women post-pandemic.

Methods: We used weighted data from the 2023 National Health Interview Survey on 15,745 women, including 2,432 rural women. We obtained unadjusted sociodemographic predictors of breast cancer screenings as well as six unadjusted breast cancer screening outcomes. We then built Firth penalized regressions estimating adjusted odds of all six outcomes in rural versus urban women in our sample.

Results: Rural women were less likely to have ever had a mammogram (60.8% vs. 64.6%, p = 0.017), and marginally less likely to have ever discussed genetic testing (8.9% vs. 10.3%, p = 0.093) or have ever gotten genetic testing for cancer risk (5.4% vs. 6.5%, p = 0.05). After adjustment, odds of ever discussing genetic testing with a doctor remained marginally lower for rural than urban women (aOR: 0.87, 95% CI: 0.74-1.02).

Conclusions: Rural-urban differences in breast cancer screening outcomes were attenuated after adjustment for sociodemographic factors, suggesting these factors primarily drive observed disparities. Addressing these upstream social determinants of health could help improve rural breast cancer screening disparities."