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This study investigated variations in breast cancer mortality among women in San Luis Potosí, Mexico using an epidemiologicalspatial approach covering the period 2009-2019. Additionally, global and specific survival and its associations with clinical stage, age at diagnosis, marginalization index, recurrence and arsenic concentration in water were evaluated. We conducted a retrospective ecological, study involving1, 626 confirmed breast cancer cases and 264 related deaths registered at a public hospital. Survival analysis was performed using the Kaplan-Meier method and Log-Rank tests. Spatial distribution patterns of municipal average mortality were assessed using Moran's I and visualized in ArcMap 10.1. At the state-level the mean age at diagnosis among deceased patients was 53.49 years, with 84% presenting at advanced stages (IIB-IV). A progressively increased mortality, particularly in Health Jurisdiction IV and the municipality of Cerro de San Pedro, was observed, with peaks in 2016. The 5-year global survival rate was 83.78%. Factors significantly associated with reduced survival included advanced stage, older age, higher marginalization index and recurrence. Although arsenic exposure was not statistically significant, patients exposed to levels exceeding 0.025 mg/L exhibited longer survival times. The integration of spatial epidemiology with survival analysis underscored critical geographic and sociodemographic disparities and offer valuable insights for targeted healthcare planning and resource allocation, particularly in high-priority regions.