Rural Cancer and the Opioid Epidemic: Are Screening Disparities Further Exacerbated?

Abstract

Objective: Rural areas experience significant disparities in cancer incidence and mortality and are also disproportionately impacted by the drug use epidemic. People who use drugs (PWUDs) frequently experience healthcare-associated stigma sufficient to cause avoidance of all non-urgent care. Research associated with cancer risk and screening utilization among rural PWUDs is nearly nonexistent. Methods: We searched PubMed for articles describing rural healthcare access and cancer disparities, and drug use and healthcare-associated stigma. Results: Rural populations frequently experience increased rates of circumstances and behaviors associated with increased cancer risk, morbidity, and mortality, but also lesser access to and use of healthcare. Rural areas have been disproportionately impacted by many types of drug use, and the stigma PWUDs frequently encounter leads to deferred care and poorer health outcomes. The limited data suggest that PWUDs experience at least equal cancer risk as their non-PWUD peers but obtain screening less often. Whereas interventions to increase medical care engagement among PWUDs have succeeded, none has explored cancer risk and screening. Conclusions: Although there are mechanisms to increase cancer screening in rural areas, and methods to increase healthcare engagement for PWUDs, research should combine these evidence-based practices to explore implementation in this population with distinct risk profiles.