Neighborhood geographic disparities in colorectal, prostate, breast, and lung cancer risk in Alabama

PURPOSE: Incidence of common cancers has been rising in the U.S., with strong geographic variation in risk factors and incidence, particularly in the Southeast and in rural and high-poverty areas. Elevated cancer risk may translate into higher geographic concentrations of cancer survivors who require surveillance, follow-up care, and supportive services. Local geospatial assessment of cancer burden may inform both cancer prevention and survivorship planning. METHODS: We utilized adult (≥ 18 years) incident cases of colorectal, prostate, breast, and lung cancers from the 2010-2019 Alabama Statewide Cancer Registry data. We performed Bayesian disease mapping to estimate census tract-level relative risks (RRs) and classified tracts as hot and cold spots at 99% credible intervals (CrIs). Stratified analyses examined median RR differences by 2010 Rural-Urban Commuting Area codes and 2010-2019 Area Deprivation Index (ADI) quartiles. RESULTS: We identified 7, 9, 3, and 83 hot-spot tracts for colorectal, prostate, breast, and lung cancer incidence, respectively. Colorectal hot spots were concentrated in rural southwestern Alabama; prostate cancer hot spots formed a band across south-central Alabama; breast cancer hot spots were localized to Huntsville and Birmingham; and lung cancer hot spots were widespread across rural areas. Increasing rurality was associated with higher median RRs for colorectal, prostate, and lung cancers. CONCLUSIONS & IMPLICATIONS FOR CANCER SURVIVORS: Neighborhood-level geographic disparities in cancer risk highlight areas with higher concentrations of cancer survivors with survivorship care needs. Linking geospatial incidence patterns with survivorship planning could support targeted strategies for surveillance, symptom management, psychosocial care, and health maintenance in high risk communities in the Deep South.