Betty Y. Liu


April 2012

Document Type


Degree Name



Dept. of Public Health and Preventive Medicine


Oregon Health & Science University


Background: Cancer is a leading cause of morbidity and mortality in the United States. Screening can prevent the incidence and mortality for colorectal and cervical cancer, and mortality for breast cancer. Chronic conditions may play a role in the receipt of patients’ cancer screening. How those conditions affect cancer screening in rural patients have not been well studied. Objective: To examine the association between the number and type of patients’ chronic conditions and the likelihood those patients are up-to-date for appropriate screening for breast, cervical, and colorectal cancer in rural Oregon. Design, Participants, Main Measures: We reviewed medical charts from four primary care clinics in rural Oregon from 2008-2009. Up-to-date status was constructed on risk status based on USPSTF guidelines. Eight chronic conditions were examined. Variables associated with those conditions were examined with random effect logistic regression analysis and odds ratios were calculated. Results: We had 3,433 patients for our analysis of colorectal cancer screening, 1859 women for breast cancer screening, and 740 women for colorectal cancer screening analysis. We identified a total of 584 (17%) patients with no condition, 802 (23%) with one, 815 (24%) with two, and 1,232 (36%) with three or more conditions. Patients with three or more conditions were less up-to-date for screening, especially for cervical cancer (OR=0.40, 95% CI: 0.23-0.70). For colorectal cancer screening in men, those with cardiovascular disease were less likely to be up-to-date (OR=0.61, 95% CI: 0.45-0.82) and those with chronic digestive disease were more likely (OR=1.80, 95% CI: 1.35-2.41). For women, those with depression were less likely to be up-to-date (OR=0.76, 95% CI: 0.60-0.97) and those with chronic digestive disease were more likely (OR=1.70, 95% CI: 1.33-2.15). For breast cancer, those with asthma and cardiovascular disease were less likely to be up-to-date (OR=0.60, 95% CI: 0.44-0.81; OR=0.70, 95% CI: 0.53-0.93), and those with digestive disease were more likely (OR=1.28, 95% CI: 1.01-1.63). For cervical cancer, those with arthritis/joint disease, diabetes mellitus, and hypertension were all less likely to be up-to-date for screening (OR=0.64, 95% CI: 0.43-0.94; OR=0.56, 95% CI: 0.33-0.96; OR=0.53, 95% CI: 0.36-0.77). Conclusions: With a more detailed understanding of cancer screening in rural primary care setting, we hope to address potential barriers for patients and modify physician practice behaviors to increase conversations for appropriate screening and adherence to guidelines.




School of Medicine



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