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UKnowledge > College of Public Health > Journal of Appalachian Health > Vol. 7 (2025) > Iss. 4

 

Corresponding Author

Jennifer Osher; OSHERJ@etsu.edu

Author Affiliations

  1. Jennifer M. Osher, MS: Medical Student, Quillen College of Medicine, East Tennessee State University (Johnson City TN); E-mail: OSHERJ@etsu.edu; ORCiD: https://orcid.org/0000-0001-7912-5508
  2. Caleb W. Brown, BA, BS: Medical Student, Quillen College of Medicine, East Tennessee State University; E-mail: BROWNCW@etsu.edu; ORCiD: https://orcid.org/0009-0007-7541-8320
  3. Phillip L. Nichols, BS: Medical Student, Quillen College of Medicine, East Tennessee State University; ORCiD: https://orcid.org/0009-0008-1470-9658
  4. Tariq Ayubi, MD: General Surgery Resident, Department of Surgery, Quillen College of Medicine, East Tennessee State University; ORCiD: https://orcid.org/0000-0001-7233-9749
  5. Jeremy M. Powers, MD: Assistant Professor, Department of Surgery, Division of Plastic and Reconstructive Surgery, Quillen College of Medicine, East Tennessee State University; ORCiD: https://orcid.org/0000-0001-6839-0058

Author Area of Expertise

Jennifer Osher: Medical education

Caleb Brown: Medical education

Phillip Nichols: Medical education

Tariq Ayubi: General surgery

Jeremy Powers: Plastic and reconstructive surgery

Abstract

Introduction: Breast cancer is the most common malignancy among women in the United States (U.S.), despite recent survival rates improving nationally. However, rural and Appalachian regions have experienced slower mortality declines. These communities face unique health care-related challenges that may contribute to observed disparities.

Purpose: The purpose of this study is to assess differences in breast cancer incidence, mortality, and mortality-to-incidence ratio (MIR) between Appalachian and non-Appalachian counties, as well as rural and non-rural counties in Virginia (VA). Furthermore, we aim to evaluate whether availability of mammography is associated with these differences.

Methods: County-level breast cancer incidence and mortality data (2015–2019) for women age 40 and above were obtained from the VA Department of Health. Mammography facility locations were obtained from the Food and Drug Administration (FDA) Mammography Database. Appalachian designation followed Appalachian Regional Commission criteria. Rurality designation followed the 2013 Rural-Urban Continuum Codes (4–9 = rural). Mammography density per eligible female population was calculated using 2016 Census data. Mean rates were compared with t-tests. Linear regression with interaction terms evaluated associations between mammography density and MIR.

Results: Of the 133 counties in VA, 33 (24.8%) were considered Appalachian and 53 (39.8%) rural. Incidence and mortality rates in woman age 40 and above did not differ significantly by Appalachian status or rurality. MIRs were higher in Appalachian (0.24 vs. 0.18; p =0.04) and rural (0.23 vs. 0.18; p =0.01) counties. Mammography density was not significantly associated with MIR by Appalachian status (p =0.97) or rurality (p =0.06) with the exception of non-rural Appalachian counties.

Implications: Despite similar incidence rates, Appalachian and rural counties in Virginia had higher MIRs, suggesting poorer survivability. Mammography availability alone did not explain disparities, necessitating further investigation.

DOI

https://doi.org/10.13023/jah.0704.03

Creative Commons License

Creative Commons Attribution 4.0 License
This work is licensed under a Creative Commons Attribution 4.0 License.

Recommended Citation

Osher JM, Brown CW, Nichols PL, Ayubi T, Powers JM. Geospatial analysis of breast cancer incidence, mortality, and access to screening in rural and Appalachian Virginia. J Appalach Health 2025; 7(4):55-69. DOI: https://doi.org/10.13023/jah.0704.03

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