J Cancer 2021; 12(2):474-481. doi:10.7150/jca.49676

Research Paper

Differences Related to Cancer Screening by Minority and Rural/Urban Status in the Deep South: Population-based Survey Results

Casey Daniel3✉, Salma Aly1, Sejong Bae2, Isabel Scarinci2, Claudia Hardy2, Mona Fouad2, Wendy Demark-Wahnefried2

1. Faculty of Medicine, Alexandria University, Alexandria, Egypt.
2. O'Neal Comprehensive Cancer Center at the University of Alabama at Birmingham (UAB), Birmingham, AL.
3. University of South Alabama College of Medicine.

This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/). See http://ivyspring.com/terms for full terms and conditions.
Daniel C, Aly S, Bae S, Scarinci I, Hardy C, Fouad M, Demark-Wahnefried W. Differences Related to Cancer Screening by Minority and Rural/Urban Status in the Deep South: Population-based Survey Results. J Cancer 2021; 12(2):474-481. doi:10.7150/jca.49676. Available from https://www.jcancer.org/v12p0474.htm

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Objective: Cancer mortality in the U.S. Deep South exceeds national levels. A cross-sectional survey was undertaken across Alabama to discern cancer beliefs and screening practices, and compare data from racial/ethnic minority versus majority and rural versus urban respondents.

Methods: Using population-based methods, we approached 5,633 Alabamians (ages 50-80) to complete a 58-item survey (administered in-person, via telephone, or the web). Descriptive statistics were used to summarize findings; two-tailed, chi-square and t-tests (α<0.05) were used to compare minority-majority and rural-urban subgroups.

Results: The response rate was 15.2%; respondents identified as minority (n=356) or majority (n=486), and rural (n=671) or urban (n=183). Mean (SD) age was 63.7 (10.2) and >90% indicated stable housing, and healthcare coverage and access. Rural and minority versus urban and majority respondents were significantly more likely to have lower education, employment, and income, respectively. Most respondents equated cancer as a “death sentence” and were unable to identify the age at which cancer screening should begin. Few rural-urban subgroup differences were noted, though significant differences were observed between minority versus majority subgroups for mammography (36.7% versus 49.6%, p<.001) and colorectal cancer screening (34.5% vs. 47.9%, p<0.001). Furthermore, while minorities were significantly more likely to report ever having a colonoscopy (82.1% versus 76.1%, p=0.041) and to have received fecal occult blood testing within the past year (17.2% versus 12.2%, p=0.046), routine adherence to screening was <20% across all subgroups.

Discussion: Cancer early detection education is needed across Alabama to improve cancer screening, and particularly needed among racial/ethnic minorities to raise cancer awareness.

Keywords: cancer screening, race, rural, mammography, colonoscopy