Abstract PS4-12-06: Breast Cancer in Appalachia: A Comprehensive Analysis of Behavioral and Socioeconomic Factors Influencing Stage at Diagnosis

Abstract Background: Breast cancer remains a leading cause of morbidity and mortality, with disparities in outcomes influenced by behavioral, demographic, and socioeconomic factors. The Appalachian region faces unique challenges due to limited access to healthcare, economic disparities, and high rates of tobacco and alcohol use. This study aims to assess whether alcohol use, smoking history, insurance status, and family history of cancer influences breast cancer staging at diagnosis. Methods: A retrospective analysis was conducted using medical records from patients diagnosed with breast cancer at Tennova North Knoxville Medical Center between 2020 and 2024. A total of 1,359 patients with breast cancer were identified. The study examined the association between alcohol use, smoking history, family history of cancer, diabetes mellitus type 2, insurance status, and breast cancer staging (AJCC 8th edition). Data on age and socioeconomic status were also considered. Descriptive and biostatistical analyses, including chi-square tests, logistic regression, and multivariable models were performed. Results: Of the 1,359 patients with breast cancer included in this study, 49.3% were diagnosed with stage III and 3.0% with stage IV breast cancer. Current alcohol use (55.7%) and smoking (14.5% current; 24.7% former smokers) were significant predictors of advanced stages (stage III or IV) at diagnosis, with current alcohol use increasing the odds of advanced disease by 2.1 times (OR 2.1, 95% CI [1.5, 2.9], p < 0.01) and current smokers being 2.5 times more likely to present with stage III (OR 2.5, 95% CI [1.8, 3.6], p < 0.01). A family history of cancer was protective, with those reporting it being less likely to present with advanced disease (OR 0.6, 95% CI [0.4, 0.9], p < 0.05). Medicaid patients and patients without insurance had significantly higher odds of presenting at advanced stages, with Medicaid being 3 times more likely to present with stage III or IV (OR 3.0, 95% CI [2.1, 4.5], p < 0.01), and uninsured patients being 5 times more likely (OR 5.0, 95% CI [2.3, 10.5], p < 0.01). Diabetes mellitus type 2 was associated with an increased risk of advanced disease (OR 1.6, 95% CI [1.2, 2.1], p < 0.01). Younger patients (<45 years) had a 2.4 higher likelihood of presenting with advanced breast cancer compared to older patients (≥ 45 years) (OR 2.4, 95% CI [1.5, 3.7], p < 0.01), suggesting delays in diagnosis, likely due to lower screening rates. Conclusions: This study performed in the Appalachian region identifies critical factors, including behavioral factors and socioeconomic disparities, and its influence on breast cancer stage at diagnosis. Current alcohol use, smoking, and government insurance/lack of insurance were found to be significant predictors of advanced-stage diagnoses, while family history of cancer was associated with breast cancer being diagnosed at an earlier stage. Additionally, Medicaid and uninsured patients presented with more advanced diseases at diagnosis, indicating that they may face barriers to early detection. These findings underscore the importance of addressing behavioral risk factors and targeting socioeconomic disparities to improve timely access to care in rural populations. Public health initiatives in the region should focus on community awareness, screening and early cancer detection programs, reducing/limiting smoking and alcohol use, and expanding access to insurance to mitigate these disparities. Citation Format: J. Gill, N. Lopetegui-Lia. Breast Cancer in Appalachia: A Comprehensive Analysis of Behavioral and Socioeconomic Factors Influencing Stage at Diagnosis [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2025; 2025 Dec 9-12; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2026;32(4 Suppl):Abstract nr PS4-12-06.