• Todd Burus, Pamela C Hull, Krystle A Lang Kuhs, Tianyan Gao, Christine F Brainson, and B Mark Evers.
• Markey Cancer Center, University of Kentucky, Lexington, Kentucky.
• J. Am. Coll. Surg. 2025 Feb 6.

BackgroundThe Appalachian region of the United States (US) extends from the Mississippi delta to southern New York. Although disparities in Appalachian cancer outcomes have long been observed, recent rates and trends have not been assessed.Study DesignWe calculated 5-year age-adjusted US cancer incidence and mortality rates for 2017-2021, stratified into Appalachian and non-Appalachian populations, as well as Appalachian subregions, using the US Cancer Statistics Incidence Analytics Database and National Center for Health Statistics mortality files. Annual rates for 2004-2021 were also calculated.ResultsIn 2017-2021, all-site cancer incidence (466.6; 95% confidence interval (CI), 465.5-467.6) and mortality rates (165.5; 95% CI, 164.9-166.1) among Appalachian residents were significantly higher (5.6% and 12.8%, respectively) than among non-Appalachian residents. Within Appalachia, the Central subregion-predominantly eastern Kentucky-had the highest rates of all-site cancer incidence (495.9) and mortality (201.9). In addition, the Central subregion had the highest rates of lung and colorectal cancer incidence, and the highest rates of lung, colorectal, and cervical cancer mortality. All-site cancer incidence and mortality rates among Appalachian individuals have decreased significantly since 2004 (-0.33%/year and -1.39%/year, respectively), with site-specific incidence rate decreases for late-stage lung (-2.19%/year), late-stage colorectal (-0.75%/year) and late-stage female breast (-0.35%/year) cancers in Appalachia.ConclusionWhile cancer incidence and mortality rates are declining in Appalachia, they remain substantially higher and demonstrate slower progress than elsewhere in the US-particularly in the Central Appalachian subregion-indicating the need for targeted research to delineate and address the factors driving these cancer health disparities.Copyright © 2025 by the American College of Surgeons. Published by Wolters Kluwer Health, Inc. All rights reserved.

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