Socioeconomic barriers and missed opportunities for early diagnosis in young-onset biliary tract cancer in Appalachian region.

533 Background: Biliary tract cancers (BTCs) are aggressive malignancies often diagnosed at advanced stages, with majority of cases occurring in older adults. However, recent trends indicate a rising incidence of BTC in individuals aged ≤50 years. In the Appalachian region, where healthcare access is limited and socioeconomic barriers are prevalent, young-onset BTC cases may be underdiagnosed or diagnosed at later stages. This study explores demographics and clinical factors of BTC patients, focusing on young individuals, and socioeconomic barriers on early diagnosis. Methods: We conducted a retrospective analysis of hospitalized patients diagnosed with BTC between January 2017 and December 2024 in a community hospital system in the Appalachian region. Patients were categorized into two age groups: ≤50 years (young onset) and >50 years. Data collected included age, sex, family history of cancer, smoking status, alcohol use, and clinical presentation. Descriptive statistics were used to assess demographic trends and risk factor distribution. Chi-square tests were employed to explore associations between age groups and categorical variables, with a p-value <0.05 considered statistically significant. Results: Among the 204 patients with BTC, 74 (36.3%) were female and 130 (63.7%) were male. A total of 22 patients (10.8%) were diagnosed at age ≤50, reflecting a significant proportion of young-onset cases. Key findings include: Family History of Cancer: 117 patients (57.4%) reported a family history of cancer, with young-onset patients more likely to have a family history (68.2%) compared to those >50 years (56.6%), though this difference was not statistically significant (p=0.28). Smoking Status: 70 patients (34.3%) were current smokers, 74 (36.3%) were previous smokers, and 55 (27.0%) never smoked. Among young-onset patients, 45.5% were current smokers, compared to 32.4% in the older group (p=0.19). Alcohol Use: 64 patients (31.4%) were current alcohol users, 49 (24.0%) had past alcohol use, and 84 (41.2%) never used alcohol. The young-onset group showed a significantly higher rate of current alcohol use (50.0%) compared to the older group (29.7%) (p=0.048). Conclusions: Our study highlights that over 10% of BTC cases in individuals aged ≤50, with a concerning trend of earlier onset in this community. Young-onset patients were more likely to report current alcohol use and a positive family history, suggesting that these individuals may have distinct risk profiles that could benefit from earlier screening. Socioeconomic barriers, including limited access to healthcare and delayed diagnoses, may contribute to the rising incidence of BTC in younger individuals. These findings underscore the need for targeted prevention strategies and earlier detection methods particularly in regions with high socioeconomic challenges such as Appalachia.