Rural Cancer Screening Rates Six Times Higher with Remote Outreach, Research Finds

Living in a rural area can impact a person’s ability to access health care services. As an example, research has shown that more than 50% of rural women in 28 states face limited mammogram accessibility. A new study aimed to see if an outreach campaign could help boost rural rates of regular screenings for several types of cancer.

A group of researchers from multiple institutions in Ohio and Indiana recently tested the impact of remote outreach on screening levels of rural women. This included interactive education and follow-up telephone support. According to findings published in JAMA Network Open, this effort was linked with a substantially higher rate of timely breast, cervical, and colorectal cancer screenings. The team says this could be an effective tool to improve health care uptake in rural communities.


Dr. Victoria Champion, first author and distinguished professor of nursing at Indiana University School of Nursing, explains, “Results of this study yield important data to carry out interventions that increase cancer screening in rural women. First, it is possible and effective to combine interventions that support breast, cervical and colon cancer screening yielding a holistic approach to early detection of cancer. Secondly, we have technology available to overcome previous barriers such as rurality and access to care. Finally, this holistic approach to cancer prevention and screening could be adapted to other behaviors that would also serve to reduce our national cancer burden.”

To gauge the effectiveness of remote outreach, the researchers recruited just under 1,000 women aged 50 to 74 from 98 rural counties in Indiana and Ohio. None of the participants had a history of cancer, but they were also not up to date on one or more of the screenings recommended by the U.S. Preventive Services Task Force.

The team notes that uptake of these breast, cervical, and colorectal cancer screenings is lower among rural residents, minorities, and people with lower incomes or education attainment.


To see if the rates could be raised in rural communities, the team tested three outreach methods: one with no outreach except study newsletters, one with a mailed interactive DVD with personalized educational information about screening and information on how to schedule appointments, and the same DVD with follow-up support calls from a patient navigator that addressed issues like barriers to screening and offered help with scheduling.

The researchers found that for the DVD group, the rates of screening for all three cancers were nearly twice as high as the group with no outreach, while the group with the DVD and follow-up calls had rates nearly six times as high.

The team says their findings suggest that this sort of outreach could be effective in raising screening rates in rural communities, and it is fairly cost effective.

The researchers explain, “Compared to treating cancer, the costs of each intervention to bring women up to date with screening were relatively modest. The average cancer treatment costs $150,000 per patient in the U.S., so the additional costs required for the addition of patient navigators to improve screening likely can result in cost savings by avoiding cancer deaths or treatment at more advanced stages.”


There were some limitations with the study, including that most participants were white and highly educated.

However, the team says going forward, these outreach tools could also pivot to the internet, as broadband continues to spread into the more rural areas of the country.

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