Abstract PURPOSE: Historically, residents of the Mississippi Delta Region have suffered from high unemployment and poverty, deficits in education, and inadequate access to health care. These factors may lead to deficits in cancer screening for women, higher incidence rates of late stage disease and higher death rates. This study assessed breast and cervical cancer mortality in the Mississippi Delta Region for 1979 through 1998. METHODS: Annual death rates for 1979 through 1998 and average annual rates for 1994-1998 were calculated for the Mississippi Delta Region (235 counties in 8 states) from information reported on death certificates. Rates were age-adjusted to the 1970 U.S. standard population. Rates for all of the Delta Region and state specific rates for the Delta region were compared to rates for the remainder of the U.S. or the states, respectively. Trends were examined with joinpoint regression techniques overall and by age and race over 1979-1998. Average annual death rates were also compared by rurality and a socioeconomic indicator of the county of residence. RESULTS: Overall breast cancer mortality was lower among white Mississippi Delta women than among other U.S. white women throughout the study period but, after rates decreased among both groups in the 1990s, the difference has narrowed. Breast cancer death rates among black women initially increased at a higher rate in the Delta region and rates remained similar in the Delta and other U.S. regions in recent years. Breast cancer death rates did not differ by economic status between regions. Cervical cancer death rates declined more rapidly in the remainder of the U.S. than the Delta region. Among white women, suburban and rural women in the Delta region had higher cervical cancer death rates than their counterparts in the other U.S. Among black women, residents of economically nondistressed or urban Delta counties had higher death rates than their counterparts in the other U.S. Death rates varied by geographic areas within states; Delta rates were elevated in 2 states for breast cancer and 6 states for cervical cancer compared to rates for the remainder of the states. CONCLUSION: The results provide information to guide prevention and control activities for reducing premature mortality from these diseases.