Health Service Accessibility and Risk in Cervical Cancer Prevention: Comparing Rural Versus Nonrural Residence in New Mexico

Abstract

Purpose Multiple intrapersonal and structural barriers, including geography, may prevent women from engaging in cervical cancer preventive care such as screening, diagnostic colposcopy, and excisional precancer treatment procedures. Geographic accessibility, stratified by rural and nonrural areas, to necessary services across the cervical cancer continuum of preventive care is largely unknown. Methods Health care facility data for New Mexico (2010-2012) was provided by the New Mexico Human Papillomavirus Pap Registry (NMHPVPR), the first population-based statewide cervical cancer screening registry in the United States. Travel distance and time between the population-weighted census tract centroid to the nearest facility providing screening, diagnostic, and excisional treatment services were examined using proximity analysis by rural and nonrural census tracts. Mann-Whitney test (P < .05) was used to determine if differences were significant and Cohen's r to measure effect. Findings Across all cervical cancer preventive health care services and years, women who resided in rural areas had a significantly greater geographic accessibility burden when compared to nonrural areas (4.4 km vs 2.5 km and 4.9 minutes vs 3.0 minutes for screening; 9.9 km vs 4.2 km and 10.4 minutes vs 4.9 minutes for colposcopy; and 14.8 km vs 6.6 km and 14.4 minutes vs 7.4 minutes for precancer treatment services, all P < .001). Conclusion Improvements in cervical cancer prevention should address the potential benefits of providing the full spectrum of screening, diagnostic and precancer treatment services within individual facilities. Accessibility, assessments distinguishing rural and nonrural areas are essential when monitoring and recommending changes to service infrastructures (eg, mobile versus brick and mortar).

Socio-demographic characteristics and associated factors influencing cervical cancer screening among women attending in St. Paul’s Teaching and Referral Hospital, Ethiopia

“…Related studies were done in Nepal [19] and Uganda [24] showed that rural women were less likely to receive screening. Another study conducted in Mexico revealed that women who reside in rural areas had a significantly greater geographic accessibility burden when compared to nonrural areas (4.4 km vs 2.5 km and 4.9 min vs 3.0 min) for screening due to these rural women were less likely underwent to cervical screening [25]. In Ethiopia, most screening facilities were available in urban hospitals while 80% of the population lives in rural areas; on the other hand, those hospitals were overburdened by advanced cases/chronic diseases; because of this reason, the participation in screening is compromised.…”

Impact of screening on cervical cancer incidence: A population‐based case–control study in the United States

“…Second, false‐positive tests have the potential to increase stress and anxiety if further diagnostic testing is required, in addition to the discomfort from a colposcopy. Additionally, there is the time and expense associated with unnecessary testing; in New Mexico, 28% of women who reside in rural areas must travel more than 30 minutes each‐way to seek diagnostic services …”

Rural‐Urban Differences in Human Papillomavirus‐associated Cancer Trends and Rates

“…Studies have reported that rural residents are less likely to receive cancer screening than their urban peers . Further, rural residents are more likely to state cost as a factor in not receiving screening, have less access to specialty cancer care, not receive physician recommendations for screening, and experience higher rates of screening‐preventable cancers and higher cancer mortality . As primary care providers have a substantial influence on their patients’ uptake of screening, a strategy may be to encourage primary care physicians to consistently recommend screening .…”