Determinants of Mammography Usage across Rural and Urban Regions of Canada

Breast cancer is a leading source of mortality among Canadian women; however early detection via mammography considerably improves survival rates. Accordingly, national guidelines advocate biennial screening for asymptomatic women aged 50 to 69 years. Unfortunately many women do not abide by such recommendations, and there is some evidence that compliance rates are lower in rural areas. This report explores the extent of regional variation within and between Canadian provinces using a new and more detailed set of rural indicators based on economic zones of influence. We find the incidence of ever having a mammogram and screening within the last two years are significantly lower for women most removed from large urban centers. This result is obtained after controlling for demographic and socio-economic characteristics, concentration of physicians and specialists in the local area and whether the woman has a regular family doctor. An important reason for the observed differences across rural and urban areas is found to be awareness of the need for regular screening. We also observe that differences in mammography usage between rural and urban areas vary significantly across Canadian provinces.