Geospatial hotspot analysis of breast cancer in Ohio: Environmental and rural–urban disparities informing targeted prevention and treatment.

Abstract

e22566 Background: Breast cancer is the most commonly diagnosed malignancy among women in the United States. In 2022, 10,627 new cases were reported in Ohio (Ohio Department of Health; Centers for Disease Control and Prevention). Breast cancer incidence varies geographically due to differences in access to care, demographics, socioeconomic factors, and environmental exposures. County- and ZIP code–level analyses can identify spatial heterogeneity and high-incidence clusters. This study evaluates Ohio county- and ZIP code–level breast cancer incidence to characterize rural–urban disparities, identify geographic hot spots, and assess associations with environmental toxic release patterns to inform targeted prevention strategies. Methods: This retrospective, population-based study analyzed deidentified data from 2018 to 2025 from the Ohio Cancer Incidence Surveillance System. Following Ohio Department of Health IRB approval and a Data User Agreement, analyses were conducted at the University of Toledo. ZIP code-level toxic release data were obtained from the Toxic Release Inventory program. Breast cancer incidence was evaluated at the ZIP code level using two-way ANOVA by rural-urban classification (0–4) and toxicity quartiles, with Tukey post hoc testing for interaction effects. Multivariable regression assessed associations among socioeconomic, demographic, and healthcare access factors, and spatial mapping identified geographic hotspots and social determinants of health. Statistical significance was defined as p < 0.05. Results: Two-way ANOVA demonstrated a significant elevation in breast cancer rates in ZIP codes located in rural counties (p = 0.0012), Toxicity quartiles were not independently associated with breast cancer rates (p = 0.0984), and no significant urban–rural–toxicity interaction was observed (p = 0.5229). Conclusions: Breast cancer rates in Ohio demonstrates geographic variation, with higher rates in the most rural counties. Identification of rural hot spots may inform targeted interventions addressing healthcare access and socioeconomic disparities. Limitations in environmental exposure assessment and disease latency support the need for studies using refined exposure metrics. Breast cancer incidence by urban–rural classification and environmental toxicity. Factor Categories Statistic (F) P value Urban-Rural Classification 0–4, (0 = most rural, 4 = most urban 4.65 0.0012 Toxicity level Quartiles (1=lowest 4=highest) 2.12 0.0984 Urban–rural × toxicity Interaction term 0.91 0.5229 Tukey post hoc (urban-rural) Pairwise comparisons (0–4) – < 0.05 Tukey post hoc testing demonstrated higher breast cancer rates in more rural categories (0-1) compared with more urban categories (2-3).