Purpose: The aim of this study was to compare health promotion behavior in middle-aged rural residents by cancer screening participation. Methods: Data were collected from 508 rural residents during the period from April 6 to June 6, 2009 using structured questionnaires, and analyzed using SPSS/WIN 12.0. Results: The cancer screening rate was 50.2%. The rate was significantly different according to sex, educational level, marital status, private insurance, family cancer history, smoking, drinking, perceived health status, and health concern. Men showed the highest screening rate in gastroscopy for stomach cancer, and women in pap smear test for cervical cancer. Pap smear test for cervical cancer showed the highest regular screening rate (4.3%). The average score of health promotion behavior was $2.65{pm}0.35$. Health promotion behavior was significantly different according to cancer screening participation, health responsibility, stress management, and self actualization. Conclusions: These results suggested that there may be differences in health promotion behavior among middle-aged rural residents according to their cancer screening participation. A further study is necessary to find effective interventions for the non-cancer screening group.