Breast Cancer Screening, Incidence, and Outcome in the Appalachian Highlands

Authors' Affiliations

Philip Nichols, Quillen College of Medicine, East Tennessee State University, Johnson City, TN

Location

D.P. Culp Center Ballroom

Start Date

4-5-2024 9:00 AM

End Date

4-5-2024 11:30 AM

Poster Number

92

Name of Project's Faculty Sponsor

Jeremy Powers

Faculty Sponsor's Department

Surgery

Classification of First Author

Clinical Doctoral Student

Competition Type

Competitive

Type

Poster Presentation

Presentation Category

Health

Abstract or Artist's Statement

Due to improvements in screening and treatment, the United States has seen a steady decline in breast cancer mortality over the past two decades. There exist, however, multiple disparities in outcomes based on socioeconomic status, race/ethnicity, as well as geographic location/urban/rural distinctions. It has previously been shown that the rural Appalachian region has seen a less significant decline in mortality compared to the rest of the country, with the most significant difference occurring when compared to urban non-Appalachian counties. A review conducted by Duffy et al. estimates that when women are invited for breast cancer screening, the risk of death is comparatively reduced by 22% across all age groups. Attending breast cancer screening is estimated to reduce breast cancer mortality by 30%. Breast cancer screening appears to be the largest factor contributing to mortality. The resource limited setting of Appalachian presents a significant obstacle to mammography. This study examined differences between Appalachian (n=33) and non-Appalachian (n=100) counties in Virginia to determine the impact of available resources on breast cancer diagnosis and mortality (2016-2020). We hypothesized Appalachian counties would demonstrate increased mortality due to lower density of mammography sites by population. Statistical analysis done using Statistical Analysis Software demonstrated no significant differences in mortality and incidence rates (P=0.14, P=0.13) between Appalachian and non-Appalachian counties. A comparison of mean mortality-to-incidence ratio (MIR), which serves as a population-based indicator for survival, demonstrated that Appalachian counties have an improved survivability rate (P=0.04). This study also examined breast cancer mortality comparing USDA designations of rural (n=53) vs non-rural (n=80) in Virginia. When comparing rurality, mortality and incidence rates demonstrated no statistical difference (P=0.07, P=0.97). Using MIR, rural counties demonstrated higher breast cancer survivability (P=0.01). To assess the relationship between mammography site density among females over 40 and survivability, simple linear regression models showed that Appalachia vs. non-Appalachian counties as well as rural vs non-rural counties, no statistically significant differences (P = 0.97, P = 0.06) were found.

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Apr 5th, 9:00 AM Apr 5th, 11:30 AM

Breast Cancer Screening, Incidence, and Outcome in the Appalachian Highlands

D.P. Culp Center Ballroom

Due to improvements in screening and treatment, the United States has seen a steady decline in breast cancer mortality over the past two decades. There exist, however, multiple disparities in outcomes based on socioeconomic status, race/ethnicity, as well as geographic location/urban/rural distinctions. It has previously been shown that the rural Appalachian region has seen a less significant decline in mortality compared to the rest of the country, with the most significant difference occurring when compared to urban non-Appalachian counties. A review conducted by Duffy et al. estimates that when women are invited for breast cancer screening, the risk of death is comparatively reduced by 22% across all age groups. Attending breast cancer screening is estimated to reduce breast cancer mortality by 30%. Breast cancer screening appears to be the largest factor contributing to mortality. The resource limited setting of Appalachian presents a significant obstacle to mammography. This study examined differences between Appalachian (n=33) and non-Appalachian (n=100) counties in Virginia to determine the impact of available resources on breast cancer diagnosis and mortality (2016-2020). We hypothesized Appalachian counties would demonstrate increased mortality due to lower density of mammography sites by population. Statistical analysis done using Statistical Analysis Software demonstrated no significant differences in mortality and incidence rates (P=0.14, P=0.13) between Appalachian and non-Appalachian counties. A comparison of mean mortality-to-incidence ratio (MIR), which serves as a population-based indicator for survival, demonstrated that Appalachian counties have an improved survivability rate (P=0.04). This study also examined breast cancer mortality comparing USDA designations of rural (n=53) vs non-rural (n=80) in Virginia. When comparing rurality, mortality and incidence rates demonstrated no statistical difference (P=0.07, P=0.97). Using MIR, rural counties demonstrated higher breast cancer survivability (P=0.01). To assess the relationship between mammography site density among females over 40 and survivability, simple linear regression models showed that Appalachia vs. non-Appalachian counties as well as rural vs non-rural counties, no statistically significant differences (P = 0.97, P = 0.06) were found.