Understanding socioeconomic barriers to breast cancer treatment in the Appalachian region.

252 Background: The Appalachian region faces persistent healthcare disparities due to its geographic isolation, limited resources, and socioeconomic challenges. Breast cancer (BC) outcomes in community settings within Appalachia are often underrepresented in national quality metrics. This study aims to evaluate patterns in BC presentation, treatment access, and outcomes, with a focus on the role of insurance coverage and time to treatment initiation according to BC subtype. Methods: A retrospective observational study was conducted using data from patients with BC treated in a community setting, years 2020-2024. Data collected included demographic characteristics, AJCC staging (8 th edition), BC subtype, systemic therapy, insurance, and mortality. Descriptive statistics summarized patient characteristics. Chi-square tests and logistic regression assessed associations between sociodemographic factors, tumor biology, and clinical outcomes. Survival analysis was performed using Kaplan-Meier estimates. Results: A total of 195 patients with BC were identified, of which 32.4% (n = 63) had triple-negative breast cancer (TNBC), 51.8% (n = 101) had HER2-positive BC, 11.2% (n = 22) had ER+/PR+/HER2-negative, and 4.6% (n = 9) had ER+/PR-/HER2-negative disease. In terms of staging at diagnosis, 38.5% (n = 75) had stage I, 32.8% (n = 64) had stage II, 16.4% (n = 32) had stage III, 7.2% (n = 14) had stage IV and 5.1% (n = 10) had unknown stage. Insurance breakdown included: 42.5% (n = 83) private insurance, 38.6% (n = 75) Medicare, 9.8% (n = 19) Medicaid, 5.6% (n = 11) had healthcare coverage offered to Veterans, and 3.5% (n = 7) were uninsured. The average time to neoadjuvant therapy initiation was 57 (±12.5 days) for TNBC and 53 (±14.3 days) for HER2-positive BC. At the time of this analysis, of all patients, 5.1% (n = 10) had died. A chi-square test revealed a statistically significant relationship between insurance type and time to therapy initiation (p < 0.05), with patients with private insurance starting treatment sooner than those with Medicare/Medicaid. Patients with TNBC demonstrated a significantly higher hazard ratio for death (HR = 2.85, 95% CI [1.42, 5.73], p = 0.003). Kaplan-Meier survival curves suggested a trend toward better survival in patients with private insurance (p = 0.062). Conclusions: This community-based analysis from the Appalachian region reveals disparities in BC outcomes, highlighting the complex interplay between insurance status, BC subtypes, differences in treatment timing and outcomes. Patients with TNBC, despite access to immunotherapy, had worse outcomes, whereas patients who received HER2-directed treatment had better outcomes. Insurance type correlated with stage at diagnosis and access to targeted therapies. Policy care delivery models must be restructured to bridge gaps in early treatment initiation and ensure equitable access to the most effective treatments.