Diabetes and Cancer Screening Rates among Appalachian and Non-Appalachian Residents of Kentucky

Background: Having diabetes may increase the odds of late-stage breast cancer. In Kentucky, the rates of late-stage disease are higher in rural than in urban areas, particularly in rural Appalachia. The objectives of the study were to examine the relationship between diabetes and cancer screening and to determine whether Appalachia residence modifies this association. Methods: One thousand thirty Kentucky adults responded to a 2008 telephone survey that measured whether they had diabetes; lived in Appalachia; had guideline-concordant screening for breast (mammogram, clinical breast examination), cervical (Papanicolaou), and colorectal (fecal occult blood test or sigmoidoscopy/colonoscopy) cancer; and whether they reported receiving mammograms regularly every 1 to 2 years. Results: Of the subjects, 16% had diabetes, 21% were Appalachian, and 32% were men. In multivariate analysis, women with diabetes had about half the odds of "regular" mammography screening (odds ratio, 0.56) compared with those without diabetes. Men and women in Appalachia had about half the odds of colonoscopy or sigmoidoscopy within the past 10 years (odds ratio, 0.54) compared with those living outside Appalachia. Conclusions: Both having diabetes and living in Appalachia were negatively associated with current and regular cancer screening. Less screening may explain late-stage diagnosis among these populations. (J Am Board Fam Med 2011;24:682-692.)