Impact of Neighborhood Disadvantage on Tumor Biology and Breast Cancer Survival

Author:

Goel Neha123,Hernandez Alexandra12,Kwon Deukwoo24,Antoni Michael H.25,Cole Steve6

Affiliation:

1. Department of Surgery, Division of Surgical Oncology, University of Miami Miller School of Medicine, Miami, FL

2. Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL

3. Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA

4. Department of Internal Medicine, Division of Clinical and Translational Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston. Houston, TX

5. Department of Psychology, University of Miami Miller School of Medicine, Miami, FL

6. Department of Psychiatry/Biobehavioral Sciences and Medicine, University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA

Abstract

Objective: The aim of this study was to evaluate the association between neighborhood disadvantage and Oncotype DX score, a surrogate for tumor biology, among a national cohort. Background: Women living in disadvantaged neighborhoods have shorter breast cancer (BC) survival, even after accounting for individual-level, tumor, and treatment characteristics. This suggests unaccounted social and biological mechanisms by which neighborhood disadvantage may impact BC survival. Methods: This cross-sectional study included stage I and II, ER+/HER2 BC patients with Oncotype DX score data from the National Cancer Database (NCDB) from 2004 to 2019. Multivariate regression models tested the association of neighborhood-level income on Oncotype DX score controlling for age, race/ethnicity, insurance, clinical stage, and education. Cox regression assessed overall survival. Results: Of the 294,283 total BC patients selected, the majority were non-Hispanic White (n=237,197, 80.6%) with 7.6% non-Hispanic Black (n=22,495) and 4.5% other (n=13,383). 27.1% (n=797,254) of the population lived in the disadvantaged neighborhoods with an annual neighborhood-level income of <$48,000, while 59.62% (n=175,305) lived in advantaged neighborhoods with a neighborhood-level income of >$48,000. On multivariable analysis controlling for age, race/ethnicity, insurance status, neighborhood-level education, and pathologic stage, patients in disadvantaged neighborhoods had greater odds of high-risk versus low-risk Oncotype DX scores compared with those in advantaged neighborhoods [odds ratio=1.04 (1.01–1.07), P=0.0067]. Conclusion and Relevance: This study takes a translational epidemiologic approach to identify that women living in the most disadvantaged neighborhoods have more aggressive tumor biology, as determined by the Oncotype DX score.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Surgery

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