Neighborhood disadvantage linked to shorter breast cancer-specific survival
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Key takeaways:
- Researchers noted the association independent of individual patient and treatment characteristics.
- Unmeasured social determinants of health and barriers to care may impact breast cancer-specific survival.
Women who resided in disadvantaged neighborhoods had shorter breast cancer-specific survival than with women from advantaged neighborhoods, according to data published in JAMA Network Open.
The finding persisted even after controlling for several individual patient and disease factors and National Comprehensive Cancer Network guideline-concordant treatment characteristics, researchers wrote.
“Combined, this persistent disparity associated with neighborhood disadvantage on breast cancer specific survival disparities ... suggests unaccounted mechanisms,” Neha Goel, MD, assistant professor of surgical oncology at Sylvester Comprehensive Cancer Center at University of Miami Miller School of Medicine, and researchers wrote. “These unmeasured inequities exist along the breast cancer care continuum, from delays in diagnosis to lack of treatment completion. For example, in disadvantaged neighborhoods, lack of access to health care resources and appropriate referrals can delay diagnosis and lead to later stage at presentation, which can result in shorter breast cancer–specific survival.”
Background and methodology
Despite a decrease in breast cancer rates across the United States due to advances in screening, diagnosis and treatment methods, persistent disparities in breast cancer survival exist and may be associated in part with neighborhood disadvantage.
Researchers conducted a retrospective, cohort study investigating neighborhood-level socioeconomic status and breast cancer-specific survival in a majority-minority population in South Florida.
The study included 5,027 women with stage I to stage IV breast cancer (mean age, 55.5 years; 55.8% Hispanic, 27% white, 17.5% Black) treated at an NCI-designed cancer center and sister safety-net hospital between Jan. 10, 2007, and Sept. 9, 2016.
Breast cancer-specific survival served as the primary outcome, with random effects frailty models performed to control for individual characteristics, including sociodemographics, comorbidities, breast cancer risk factors and access to care, as well as tumor and NCCN guideline-concordant treatment factors. They measured neighborhood socioeconomic status using the Area Deprivation Index for at the census block group level for each patient.
Researchers reported mean follow-up of 60.3 months, with data analysis performed from March 2022 to March 2023.
Results, next steps
Findings showed women living in the most disadvantaged neighborhoods had shorter breast cancer-specific survival than those living in the most advantaged neighborhoods (HR = 1.29; 95% CI, 1.01-1.65), independent of other characteristics.
Other factors significantly associated with higher breast cancer-specific mortality included non-Hispanic Black race (HR = 1.7; 95%CI, 1.26-2.3) and aggressive tumor subtype (ER-negative/ERBB2-negative; HR, 2.07; 95%CI, 1.67-2.56).
Additional research is needed into more aggressive tumor biologic factors among women with breast cancer from disadvantaged neighborhoods compared with women from advantaged neighborhoods, according to the researchers.
“This study therefore may advance the field of breast cancer disparities research by suggesting additional pathways by which neighborhood disadvantage may affect breast cancer-specific survival disparities beyond access to care,” Goel and researchers wrote in the study. “This strengthens the call to action for future research on the biologic mechanisms by which neighborhood disadvantage affects breast cancer biologic factors and ultimately breast cancer-specific survival.”
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