Geospatial Analysis of Breast Cancer Incidence, Mortality, and Access to Screening in Rural and Appalachian Virginia.

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; 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.