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Geographic disparities in cancer screening and fatalism among a nationally representative sample of US adults
  1. Jennifer L Moss1,2,
  2. Rebecca Ehrenkranz1,
  3. Lilian G Perez1,
  4. Brionna Y Hair1,
  5. Anne K Julian1
  1. 1 National Cancer Institute, Bethesda, Maryland, USA
  2. 2 Family and Community Medicine, Penn State College of Medicine, Hershey, Pennsylvania, USA
  1. Correspondence to Dr Jennifer L Moss, Surveillance Research Program, National Cancer Institute, Bethesda, MD 20892, USA; jmoss1{at}


Background Cancer screening in the USA is suboptimal, particularly for individuals living in vulnerable communities. This study aimed to understand how rurality and racial segregation are independently and interactively associated with cancer screening and cancer fatalism.

Methods We used data from a nationally representative sample of adults (n=17 736) from National Cancer Institute’s Health Information National Trends Survey, 2011–2017, including cancer screening (colorectal, breast, cervical, prostate) among eligible participants and cancer fatalism. These data were linked to county-level metropolitan status/rurality (US Department of Agriculture) and racial segregation (US Census). We conducted multivariable analyses of associations of geographic variables with screening and fatalism.

Results Breast cancer screening was lower in rural (92%, SE=1.5%) than urban counties (96%, SE=0.5%) (adjusted OR (aOR)=0.52, 95% CI 0.31 to 0.87). Colorectal cancer screening was higher in highly segregated (70%, SE=1.0%) than less segregated counties (65%, SE=1.7%) (aOR=1.28, 95% CI 1.04 to 1.58). Remaining outcomes did not vary by rurality or segregation, and these variables did not interact in their associations with screening or fatalism.

Conclusion Similar to previous studies, breast cancer screening was less common in rural areas. Contrary to expectations, colorectal cancer screening was higher in highly segregated counties. More research is needed on the influence of geography on cancer screening and beliefs, and how access to facilities or information may mediate these relationships.

  • cancer
  • screening
  • fatalism
  • rural
  • racial residential segregation

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  • Contributors JLM conceptualised the study, cleaned the data, ran analyses and drafted the manuscript. RE, LGP, BYH and AKJ ran analyses and drafted the manuscript. All authors reviewed, edited and approved the final manuscript.

  • Funding HINTS is funded by the National Cancer Institute. This manuscript was prepared or accomplished by the authors as part of official duty at the National Institutes of Health.

  • Disclaimer The opinions expressed in this article are the authors’ own and do not reflect the view of the National Institutes of Health, the Department of Health and Human Services, or the US government.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Data collection for HINTS was approved by the Office of Management and Budget (0925-0538), and the current analysis was reviewed by NCI and its contract partner, Westat.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement A public-use version of this dataset is available at