People living in long-impoverished areas are more likely to have aggressive or advanced breast cancer, undergo the most invasive treatments, and are more likely to die of the disease, a study found

How Your Neighborhood Might Affect Your Breast Cancer Outcome

People living in long-impoverished areas are more likely to have aggressive or advanced breast cancer, undergo the most invasive treatments, and are more likely to die of the disease, a study found

• People who live in long-impoverished neighborhoods are more likely to have worse outcomes if they develop breast cancer, a new study found.
• These disparities can be explained by socioeconomic barriers such as lack of healthcare access and existing racial inequities affecting populations living in these areas.
• To change course, root causes of poverty need to be addressed, but experts say improving access to healthcare for people living in poverty is the best place to start.

The socioeconomic status of your neighborhood could raise or lower your chances of poor breast cancer outcomes, according to new research.

A new study—published in JAMA Open Network on Aug. 29—found that women living in areas with persistent poverty are more likely to have aggressive forms of breast cancer compared to people living in neighborhoods without persistent poverty. These women were also more likely to receive more invasive treatments and were more likely to die of the disease.

About 270,000 women in the United States are diagnosed with breast cancer every year, Centers for Disease Control and Prevention (CDC) data show. Breast cancer is the second most common type of cancer in women, but screening and treatment are heavily impacted by racial and socioeconomic disparities.

“It’s a complex interplay between the environment, and the conditions in which people live, and biology,” Lorna McNeill, PhD, MPH, professor and chair of the Department of Health Disparities Research at the University of Texas MD Anderson Cancer Center, told Health.

Here’s what experts had to say about why a woman’s neighborhood can impact her risk of negative breast cancer outcomes and how to bridge the gap between high and low-income people with the disease.

Examining the Link Between Neighborhood and Breast Cancer

In their study, researchers at The Ohio State University used data from more than 312,000 women who had been diagnosed with breast cancer between 2010 and 2018. On average, the women were 62 years old, and about 6.4%—some 20,000 women—lived in areas with persistent poverty. This meant that 20% or more of the neighborhood’s population had lived below the federal poverty level for 30 years.

The researchers found that women with breast cancer living in these very low-income neighborhoods were more likely to have more aggressive forms of the disease, such as breast cancer diagnosed at a later stage or triple-negative breast cancer (TNBC). Late-stage breast cancer and TNBC are both more difficult to treat.

Women living in neighborhoods with persistent poverty were also more likely to undergo invasive treatments for their breast cancer. Among this group, mastectomies—the removal of one or both breasts—were more common. The same was true for axillary lymph node dissection, a procedure where doctors remove lymph nodes from the armpit to stop the cancer from spreading there.

Participants living in impoverished neighborhoods were also 10% more likely to die of the disease and had a 13% higher risk of mortality from any cause.

The researchers noted additional disparities in their findings—women who identified as Black or Hispanic were more likely to live in these neighborhoods with persistent poverty.

Why Do These Disparities Exist?

People living in persistently impoverished areas face barriers that affect multiple social determinants of health, study author Samilia Obeng-Gyasi, MD, MPH, assistant professor in the Division of Surgical Oncology at The Ohio State University, told Health.

A person’s education, employment, and access (or lack thereof) to quality healthcare can all play a role in breast cancer outcomes, she said.

For example, women living in poverty may have a harder time accessing breast cancer screening due to a lack of care centers in the area, a lack of health insurance, or an inability to make appointments because of work or transportation issues. As a result, these women may be at a higher risk of late-stage diagnosis.

Women living in impoverished neighborhoods may also be more likely to be exposed to air pollution or other environmental risks that can increase breast cancer risk, as well as a lack of nutritious food.

Racial Disparities Are Closely Connected

The differences in breast cancer outcomes between higher- and lower-income neighborhoods can also be in part explained by racial demographics; Black and Hispanic women—who were more likely to live in areas with persistent poverty—experience a number of breast cancer health disparities.

Although Black women have a 4% lower incidence of breast cancer as compared to white women, Black women are 40% more likely to die of breast cancer. Hispanic women are seeing drops in mortality rates due to breast cancer, but at a slower rate as compared to white women.

Additionally, Black women are nearly three times as likely to be diagnosed with TNBC, which is aggressive and hard to treat, as compared to white women. They are also more likely to have their breast cancer detected at a later stage.

This higher prevalence of aggressive and later-stage cancers could explain why women living in persistently impoverished neighborhoods also underwent more aggressive treatments, Obeng-Gyasi said.

However, disparities could also play a role, added Eric Winer, MD, director of the Yale Cancer Center and professor of medical oncology at the Yale School of Medicine. Healthcare providers may be “less willing” to discuss less-invasive treatment options with low-income patients, or patients may not understand their full range of options, he said.

“Not having health insurance, living in poverty, and being a Black woman, all of these things together [are] the perfect storm for a bad cancer outcome,” Winer told Health. “All of it relates back to systemic racism.”

Creating Better Breast Cancer Outcomes, No Matter Where You Live

Though genetics can play a role in some of these breast cancer disparities, experts agree these social determinants of health need to be addressed to ensure that women of color and women living in lower-income neighborhoods don't experience worse breast cancer treatment and outcomes.

“These neighborhoods and communities have been under-resourced and under-invested in. They have the lack of resources that other affluent areas have, access to healthy food, healthy places to be physically active, and are less likely to have places to go where you can get a mammogram,” McNeill said. “Places like these typically are more populated by people of color.”

McNeill and Winer agreed that expanding access to affordable healthcare in impoverished neighborhoods is a place to start. This might include using mobile clinics for screening, or investing in Medicaid or other programs that help people afford healthcare.

“We’ve collected enough data to know there is a huge problem, and it’s now time to try to intervene,” Winer said. But fixing the root causes of poverty will take time, he noted.

“If you gave me the choice of making five new drugs for treating breast cancer or eliminating health disparities, and asked which would have the biggest impact on breast cancer outcomes, I would tell you eliminating health disparities would have the bigger impact,” Winer said.

This story originally appeared on: Health News - Author:Kaitlin Sullivan