A Conversation About Cancer Rates in Appalachia

Rural Appalachia has some of the highest cancer mortality rates in the country — up to 36 percent higher than what is seen elsewhere. The culprit? That’s a multi-fold answer. Kara Lofton talked about cancer rates in Appalachia with freelance reporter Lyndsey Gilpin, who wrote a story addressing the discrepancy. Data journalism website FiveThirtyEight published the story earlier this month.

In one of the opening paragraphs of the article you write: “In rural Appalachian Kentucky, the cancer mortality rate is 36 percent higher than it is for urban, non-Appalachian people in the rest of the country; in rural Appalachian Virginia it is 15 percent higher; in those areas of West Virginia, 19 percent. Those are pretty stunning statistics. What is going on in rural Appalachia to make cancer rates so much higher here?

It’s really because of this perfect storm of unfortunate circumstances. You have a rural population with very high obesity rates, high rates of smoking, really high poverty rate, a  high unemployment rate and then you have a lack of education. And then on top of that you have the health care side of things with lack of access to preventive care and lack of access to really good treatment. 

You also write that “[p]eople in much of rural Appalachia are more likely to die within three to five years of their diagnoses than those in both urban Appalachian areas and urban areas across the U.S. Why is that?

That’s primarily because of this lack of access we’re talking about. And even when people can get care they have to drive farther and wait longer and perhaps not have access to advanced clinical trials or really great health care systems hospitals – things like that – that can provide them with the best kind of available resources for the best outcomes and survival rates. 

Preventive screenings are one of the best tools we have to catch cancer early. What role does access to preventive services – or access to care at all – have on cancer rates in Appalachia?

Preventive care is perhaps the biggest piece of this puzzle. From everyone I talked to it seemed like that was the part they are trying to fix and it could be the most immediate fix. And so a lot of the cancers they focused on were preventable cancers. So breast cancer, colon cancer, lung cancer and cervical cancer. There are a lot of barriers to get to the point when they can access something as easy as a screening.

You mention in the article that economic, social and environmental factors also play a role in cancer incidence. What is going on in rural Appalachia that is different from the rest of the country?

Lifestyle is a big part of it, but lifestyle factors have a lot to do with the economics and the social and environmental factors. So obviously this isn’t new to anyone I talked to in Appalachia. Poverty and the decline of the coal mining industry have a very real effect on specific health care outcomes.

Appalachia is well known as a hub for commercial coal production. Is coal mining causing higher cancer rates?

It’s not as clear as that. We can’t draw the direct connection between coal pollution in cancer. Almost everyone I spoke to that was living in eastern Kentucky talked about the fact that they were leery about water contamination  and its relationship with cancer or other chronic illnesses, but if you look at the research there’s not enough to prove that link. There is research that shows mortality and chronic illnesses are higher in coal producing counties. 

Appalachia Health News is a project of West Virginia Public Broadcasting, with support from the Benedum Foundation, Charleston Area Medical Center and WVU Medicine.