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Abstract: Breast cancer death rates in the U.S. have decreased in recent decades, however areas such as Appalachia with fewer cancer care resources may not have experienced comparable mortality declines. This study examines trends in breast cancer mortality rate disparities in Appalachian states and the continental U.S. using data from SEER mortality files 1969-2007 and the Area Resource File. Overall breast cancer mortality rates decreased significantly, with a smaller decline in Appalachian counties (17.5%) compared with non-Appalachian counties in Appalachian states (30.5%), and compared with non-Appalachia U.S. counties (28.3%). After accounting for poverty, rural/urban status, education, health care resources, and proportion White in the population, residence in Appalachian counties except for those in the Northern subregion was significantly associated with smaller reduction in breast cancer mortality rates. Lower levels of education, physician density, and percent White in the population were also associated with smaller reductions in breast cancer mortality.
Key Words: Breast cancer, mortality, Appalachia, disparity.
Breast cancer is the most commonly diagnosed non-skin cancer and the second leading cause of cancer deaths among U.S. women.1 Breast cancer death rates have decreased since 1990, declining from 33 per 100,000 in 1990 to 23 per 100,000 in 2006.1 This decline has been attributed to increased early detection through mammography, as well as to improvements in breast cancer treatment.1-3 Geographic areas that are medically underserved with fewer mammography facilities and more limited options for cancer treatment,4,5 however, may not have experienced comparable declines in breast cancer mortality.
Appalachia is a geographic region that has long been characterized by poverty and reduced health care access.6-9 Based upon disparities in cancer incidence and outcomes, residents of the Appalachian region have been designated as a special population of interest by the National Cancer Institute.10 Women in Appalachia report fewer mammograms and being less likely than others to receive recommended treatment for breast cancer.6,11 Despite these barriers, researchers reported that during 1976-1996 breast cancer mortality rate was lower among Appalachian White women than among White women in other geographic regions.12 It was the case, however, that this difference decreased over time.12
This study examines trends in breast cancer mortality rate disparities and rate reductions in Appalachian states and the continental U.S. The objectives of this research were: (I) to examine...