rural healthcare disparities; mammography; primary healthcare; prevention and control; early detection of cancer, United States


Community Health and Preventive Medicine | Health Services Research | Women's Health


Rural health clinics (RHCs) and federally qualified health centers (FQHCs) play a vital role in initiating cancer screening in underserved, rural settings. Yet there is limited information about their involvement in diagnostic tests when a mammogram result is abnormal. Diagnostic resolution of abnormal mammograms varies widely by geographic location and resources, and timely resolution is important for addressing rural-urban cancer disparities. This mixed methods study in a rural region of Missouri with high rates of cancer mortality examined the roles of primary care providers during follow-up after an abnormal mammogram, the processes they used, and the clinic specific variations among these roles and processes. Our data show substantial involvement of primary care during follow-up, with differences in resources and formalized and informal strategies between FQHCs and RHCs. Elucidating roles and processes is a necessary step before evidence based strategies, often developed in urban settings, can be adapted for rural settings.