The Appalachian region is known for its beautiful mountains, close-knit communities, and health care disparities including higher rates of cancer and premature mortality. Being diagnosed with cancer in the region may present a unique experience for survivors in regards to family cancer communication and changing personal identities. In a multiphasic study, the stories of 29 female Appalachian cancer survivors were collected through either a day-long modified story circle event (n=26) or an in-depth interview (n=3). Qualitative content analysis was used to identify emergent themes in the data. The analysis revealed 5 types of family cancer communication and five barriers to family cancer communication. The analysis additionally revealed the identity struggle women experience between maintaining traditional Appalachian gender roles and surviving cancer. These findings suggest that female Appalachian cancer survivors appear to have additional challenges that may make the cancer experience in Appalachia unique.