Mountaintop coal mining in the Appalachian region in the United States causes significant environmental damage to air and water. Serious health disparities exist for people who live in coal mining portions of Appalachia, but little previous research has examined disparities specifically in mountaintop mining communities. A community-based participatory research study was designed and implemented to collect information on cancer rates in a rural mountaintop mining area compared to a rural non-mining area of West Virginia. A door-door health interview collected data from 773 adults. Self-reported cancer rates were significantly higher in the mining versus the non-mining area after control for respondent age, sex, smoking, occupational history, and family cancer history (odds ratio = 2.03, 95% confidence interval = 1.32-3.13). Mountaintop mining is linked to increased community cancer risk. Efforts to reduce cancer and other health disparities in Appalachia must focus on mountaintop mining portions of the region.