Within the context of socioeconomic disparity in rural Appalachia, these may be compounded by patients’ ability to access sufficient care, seek out genetic testing and family history evaluation, and obtain proper treatment [9]. In this case series, we report upon three white female patients in their forties presenting with uterine leiomyomas. This report highlights previously unidentified patterns in cancer disparity in Appalachia within the context of FH-deficient uterine leiomyomas, paving a path toward more equitable care. Here, FH is linked to Uterine leiomyoma.