The biggest issue, experts said, is lack of access to care — whether it’s preventive screenings or cancer treatment. If one of Owsley County’s 4,600 residents needs to visit the doctor, they have three choices: the health department or two clinics. But doctors are not always available or working, and opportunities for screening vary. For instance, mammograms are only offered once a month at the clinics, and colon cancer screenings are referred out of the county, and cervical cancer screenings are done weekly at the health department and daily at the clinic, Lucas said. The three regional hospitals are at least a 30-minute drive away on narrow, curvy mountain roads. The Markey Cancer Center in Lexington is a far drive for people in rural Appalachia.