Year of Publication



Public Health

Date Available


Degree Name

Master of Public Health (M.P.H.)

Committee Chair

Ann Coker, MPH, PhD

Committee Member

Steven Fleming, PhD

Committee Member

Steven Browning, PhD


Background: Women living in rural and under-resourced Appalachian Kentucky may experience delays in receiving cancer treatment yet such delays have not been systematically evaluated. In this analysis, we hypothesize that women diagnosed with breast cancer who live in Appalachian Kentucky would be more likely to have a treatment delay compared to those living in other Kentucky regions and adjusting for individual measures of socioeconomic status.

Methods: In this cohort study, women included in the Kentucky Cancer Registry with a diagnosis of an incident, primary breast cancer in the prior 12 months were interviewed by phone (n=1,245; response rate 26.9%). Cox proportional hazards regression analysis was used to estimate rates of any treatment initiation and rates of specific types of first treatment of Appalachian residence relative to non-Appalachian residence after a breast cancer diagnosis.

Results: In contrast to our hypothesis, Appalachian women received any first cancer treatment sooner than non-Appalachian women after adjusting for age and stage (adjusted hazard ratio= 1.14; p=0.04). When additionally adjusting for income and health insurance, this association was no longer statistically significant (adjusted hazard ratio=1.11; p=0.14). Among women diagnosed at an earlier stage (n=899), Appalachian residents received first treatment (primarily surgery) sooner than Non-Appalachian women (p=0.05) and among those diagnosed at a later stage (n=346), Appalachian residence received radiation sooner than non-Appalachian residents (p=0.06). There were 2 also no statistical differences in receipt of chemotherapy or hormone therapy between Appalachian and non-Appalachians.

Conclusion: Our results indicate for the first time no disparity related to breast cancer diagnosis-treatment intervals in Appalachian Kentucky as compared with the rest of the state.

Included in

Public Health Commons