Scientists sent DVDs to women in rural Ohio. The result: Cancer screenings increased six-fold.
Many people have shunned DVDs in favor of streaming movies and shows — but cancer researchers are embracing them.
A team of scientists recently sent tailored, interactive DVDs to women throughout rural Ohio to educate and remind them to be screened for breast, cervical and colorectal cancers — three cancers that account for 40% of new cancer cases and a quarter of cancer deaths among U.S. women each year, according to the Centers for Disease Control and Prevention.
The innovative approach worked: Women who received a DVD were nearly twice as likely to obtain all the screenings compared to women. And those who were also paired with a patient navigator by phone had a six-fold greater chance of getting a screening, according to the study by researchers from Ohio State University Comprehensive Cancer Center and the state.
The study, published in JAMA Network Open, included 960 women who were not up-to-date on screenings, aged 50 to 74.
Timely screenings are important to catch disease at an earlier stage, but rural women have lower rates of screening for all three of those cancers.
After lung, breast cancer is the second-leading cancer-related cause of death for U.S. women at 19.4 deaths per 100,000, with colorectal next at 10 deaths per 100,000, according to 2019 data from the CDC.
Cervical cancer deaths are less deadly, with a 5-year survival rate of 91% if caught before it spreads, but that survival rate drops to 19% when metastasized.
The methods of this study build on previous research that shows how effective tailored outreach strategies can be for rural patients, who are seeing hospitals and women's heath care centers shut down, experts say. Meanwhile, many rural residents still lack broadband, which hinders telehealth services.
More: Breast cancer screening should start at age 40 – 10 years earlier than previous advice, group says
What the study did
Nearly a quarter of people living in rural areas, or around 14.5 million people, lack a fixed broadband service, according to the Federal Communications Commission.
That’s why the team chose to use DVDs, which provided information to patients about risk, age group, family history and the benefits of screening, said study coauthor Electra Paskett, a cancer epidemiology professor at Ohio State University.
“The question still is access: Not only broadband access, internet access, but access to a computer or a smartphone, which is not universal,” Paskett said.
The navigators, who were social workers, then called the women to help set up screenings and find assistance to navigate barriers like transportation. This approach helped focus on the woman's "specific needs and location," she said.
The tailored approaches can really move the needle in helping patients get screened, as seen throughout the pandemic with community-level vaccination campaigns, Paskett explained.
For example, a 2020 study found that women from Mexico in Los Angeles County who watched a culturally-tailored, Spanish-language narrative film about cervical cancer, compared to those who watched a nonnarrative film, were more likely to have gleaned greater knowledge of the disease. They were also more likely to schedule a pap smear within six months of the study.
More: When should breast cancer screenings start? Black women aren't given a good answer.
Health care shortages in rural America
Rural lands are home to about 23% of U.S. women. More than half — 58% — of the rural aging population 65 and older are women. While cancer rates are slightly lower in rural areas compared to urban, cancer-related deaths are significantly higher — 180 deaths per 100,000 compared to 158 in urban areas, the CDC reports.
An analysis of more than 132,000 breast cancer patients between 2013 and 2016 found women in rural areas made up larger proportions of those with triple negative breast cancer, a subtype that’s fast-spreading and harder to treat.
Meanwhile, a shortage of OBGYNs also plagues rural America, and rural people are getting farther from health care services and generally lack access to specialists like oncologists. The National Rural Health Association found that the ratio of patients to primary care doctors was roughly 40 doctors per 100,000 people in rural areas, compared to 53 doctors per 100,000 people in urban areas.
“When you start thinking about the community-level factors, there tends to be more concentrated poverty in rural areas and the industries that are typically located in rural areas, like agriculture, are less likely to offer health insurance coverage to their workers,” said Robin Yabroff, scientific vice president of health services research at the American Cancer Society.
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The bottom line: One screening isn't enough
Given those burdens, eliminating barriers to screening for rural patients so they can get consistent and early screened is important, experts like Yabroff say.
“The goal of cancer screening is to identify any cancer early – when treatment can be more effective and prognosis is generally better,” she said. “Historically, one of the strongest predictors of whether people get screened for cancer as recommended is whether or not their provider recommends that – if they have a usual source of care.”
Yabroff, who studies the financial burdens of cancer, said other factors that can help increase screening rates, along with reminders from providers and tailored outreach, is ensuring insurance coverage, such as through Medicaid expansion and other ways.
Yabroff noted that one screening is not enough and policymakers need to help sustain efforts to consistently improve access to cancer screenings in rural women.
“It's also important to make sure that they maintain that cancer screening – that if they do have an abnormal screening test, that they get timely follow up,” she said. “It's a part of the bigger process. Not only is regular screening important, but should someone be diagnosed with cancer, making sure they have access to timely and high-quality cancer care.”
Reach Nada Hassanein at nhassanein@usatoday.com or on Twitter @nhassanein.
This article originally appeared on USA TODAY: Cancer in rural America: Ohio study uses DVDs to get women screened
