Researchers Aaron Yao, Ph.D., and Dr. Rajesh Balkrishnan from the Medical School have analyzed cancer incidence data for rural Appalachia and found an increase in the cancer incidence rates from 1969. In their recent paper published in the Journal of Rural Health, Yao and Balkrishnan note that although these rates have been decreasing around the country, rural Appalachia has had an increase most likely because of lifestyle and environmental factors. Rural Appalachia has the country’s highest smoking rate, which is coupled with an increasing rate of obesity, according to Yao. Smoking and obesity are both known risk factors for cancer. Furthermore, many of the people from rural Appalachia made their livelihood by working in coal mines placing them at further cancer risk, especially for lung cancer. Yao said the true novelty in this paper, however, was not in the methods or the numbers, but rather in the documentation of disparities across the continuum of cancer care. “I’ve seen papers talking about death rate, incidence rate, but I tried to show that it’s not just about death rates or incidence,” Yao said. “I tried to show the problems at any stage of cancer care from risk factors to diagnosis to screening to survivorship to death rates.” Balkrishnan noted that this discrepancy in healthcare in rural Appalachia is because of an overall lack of access to resources. “A combination of poverty, maybe some poor lifestyle choices, as well as geographical barriers to accessing medical care — they all act together to create a situation where the prevalence of some of these conditions like cancer becomes more frequent,” Balkrishnan said. Yao, who grew up in rural China, finds the differences between his hometown and rural Appalachia to be very surprising. “My hometown — I feel like we have more college graduates than rural Appalachia in my hometown,” Yao said. “My brothers and sisters work in a factory, have stable jobs, have government health insurance so it’s different. … I lived in rural Appalachia during my Ph.D. studies so I know what the life is like in rural Appalachia. So it’s disturbing to see these disparities in an advanced economy like the United States — it’s almost like two Americas.” Decreasing the cancer incidence rates involves more than simply improving the healthcare system, according to Yao. The economy as a whole is weak, which has compounded other social problems such as substance abuse and unemployment. The two different approaches to decreasing the cancer incidence rates in this region focus on the economy and the healthcare system itself. In terms of the economy, Yao suggests bringing in foreign companies to boost the economy in rural Appalachia and changing its agricultural basis. One issue facing health care systems in Appalachia is that specialty doctors such as oncologists do not have practices in rural regions due to the sparse population. One approach to mitigating this problem involves the use of technology. Yao is currently designing a pilot program where elderly homebound patients with cancer can receive care through telemedicine such as the prescription of medications. “We can visit this patient once but then we can give them smart devices … that can monitor this patient’s condition and then give them care through telemedicine. You know, prescribing or things like that,” Yao said. As more attention is being redirected to better understand the factors leading to the increase in the cancer incidence rate, more programs are being implemented and designed to improve the conditions of rural Appalachia. “Develop[ing] more targeted intervention to these communities will help them lead a healthier lifestyle, [and] I think, is sort of key to combating these issues,” Balkrishnan said.