Abstract only e13620 Background: Breast cancer is the most common female malignancy diagnosed in the US. According to the CDC and WWAMI Rural Health Research Center, rural areas have a lower incidence of cancer than urban areas, yet have higher breast cancer related death rates (1,2). Adverse cardiac outcomes may contribute to decreased survival in rural populations. In this abstract, we discuss how environment impacts survival and cardiac outcomes in patients with breast cancer. Methods: An IRB-approved retrospective study was performed utilizing ICD codes to analyze patients diagnosed with biopsy-confirmed breast cancer between January 1, 2014 and December 31, 2017. 478 of 1618 de-identified patients qualified for this study. Statistical analysis was performed with SAS v9.4. Descriptive statistics were computed for all study variables. Continuous variables were described with measures of central tendency (mean, median) and dispersion (range, standard deviation). Categorical variables were summarized as frequencies and percentages. Comparisons between categorical variables were compared with the Chi-Square test (or Fisher’s Exact) where appropriate. Survival curves were estimated using Kaplan-Meier methodology and analyzed with a log rank test. Predictors of survival were assessed with Cox proportional hazards regression analyses. All significance is assumed at the p < 0.05 level. Results: Of 478 eligible patients, the calculated HR was 0.323 with 95% CI between 0.074 and 1.397 (p = 0.130), suggesting greater likelihood of survival in the urban population as compared to the rural population. Cardiac events like heart failure and ACS resulted in Fisher’s Exact p-value of 1, suggesting no significant difference in cardiac outcomes between the two populations. While results were not statistically significant, the trend of decreased survival in the rural population is noteworthy. Conclusions: Per our study, urban populations may have higher propensity for survival as compared to rural populations. There was no statistically significant difference in cardiac events among the two different population. Socioeconomic factors may play a large role in improved survival outcomes in the urban population, which may include but are not limited to travel to/from appointments and cost of medical care. Further large-scale, prospective studies should be performed to confirm the aforementioned trends with respect to survival outcomes in urban and rural populations.