Does residency (rural vs. urban) influence the uptake of cervical, breast and colorectal cancer screening in Scotland?

Problem

It has been documented in the literature that rural dwellers tend to have poorer cancer survival rates, are more likely to experience cancer-related mortality and typically present with more advanced disease compared to their urban counterparts. A previous systematic review established a general pattern of lower screening uptake in breast, cervical and colorectal screening among rural dwellers in multiple countries across the world. However, of the studies included, few were conducted in the United Kingdom and even fewer focused on Scotland. We aimed to investigate whether there was a difference in cervical, breast and colorectal cancer screening uptake between rural and urban areas across Scotland.

Approach

Datasets for cervical, breast and colorectal screening were obtained from Public Health Scotland. For each cancer dataset, we calculated screening uptake rate with separate estimates for residency status (urban/rural) as determined by the Scottish Government Rural Urban Classification, age group, sex (colorectal only), year, health board and Scottish Index of Multiple Deprivation (SIMD) quintile. To-way interaction effects were investigated between residency status and SIMD quintile, and residency status and health board. Median GP list size (by health board), Shetland & Orkney data and Breast Screening Programme interviews were conducted to supplement and contextualise quantitative data.

Findings

Cervical screening (25-49 years): Uptake was higher in rural areas (73.3%) compared to urban areas (69.7%). After adjustment, there was no observed interaction between residency status and deprivation. Two health boards demonstrated higher rural uptake, two demonstrated lower rural uptake and seven demonstrated no difference.Cervical screening (50-64 years): No significant difference in uptake in rural (75.7%) or urban (75.7%) areas. After adjustment, there was no observed interaction between residency status and deprivation. Four health boards demonstrated higher rural uptake, two demonstrated lower rural uptake and five demonstrated no difference.Breast screening: Uptake was higher in rural areas (77.1%) compared to urban areas (71.0%). After adjustment, as deprivation increased, screening uptake in rural areas increased. Three health boards demonstrated higher rural uptake, two demonstrated lower rural uptake and nine demonstrated no difference.Colorectal screening: Uptake was higher in rural areas (62.5%) compared to urban areas (56.6%). After adjustment, as deprivation increased, screening uptake in rural areas increased. Ten health boards demonstrated higher rural uptake, two demonstrated lower rural uptake and two demonstrated no difference.

Consequences

Cancer screening uptake and residency status share a complex relationship. Generally, rural residency appeared to be associated with increased odds of screening uptake across Scotland. However, the pattern of screening uptake is much less consistent when confounders are considered. Reasons for the variation seen may be partly explained by differences in organisation between screening programmes and the topography of Scotland.