The influence of rural residency on the uptake of screening for breast, cervical, and colorectal cancers in Scotland

BACKGROUND: There has been little examination of rural-urban residency and cancer screening. We investigated rural-urban variations in breast, cervical, and colorectal cancer screening uptake across Scotland. METHODS: Using aggregate data and cross-sectional analyses, we calculated uptake and detection rates (breast and bowel screening). We modelled uptake by urban and rural residency, age group, sex (bowel screening only), year, health board, and deprivation using multivariable logistic regression with appropriate interaction terms. RESULTS: Cervical screening uptake was higher in rural than urban areas (under 50s: 75.9% vs. 69.1%; 50+: 77.5% vs. 75.3%). Mammography uptake was: 77.0% in rural; 71.0% in urban areas. Bowel screening uptake was: 56.6% in urban; 62.5% in rural areas. In multivariable models, two-way interaction effects between residency and deprivation, and between residency and health board, were statistically significant (P < .05). Rural residency did not confer universally higher uptake. Breast and bowel cancer detection were similar in both areas. CONCLUSIONS: The relationship between residence and cancer screening uptake varied across Scotland. Uptake patterns were complex and not consistent across all rural areas, likely reflecting Scotland's topography and characteristics of the screening eligible. Efforts to improve screening uptake would likely benefit from local rather than national public health policies.