Women From Neighborhoods That Lack Resources Have Worse Breast Cancer Survival Rates
Women living in low-income neighborhoods with few resources had worse breast cancer survival rates than women living in more affluent neighborhoods, even after the researchers took into account a number of factors that could affect the results, including cancer characteristics, access to care, and risk factors.
The research was published online on April 21, 2023, by the journal JAMA Network Open. Read “Neighborhood Disadvantage and Breast Cancer-Specific Survival.”
About the study
A discriminatory practice called redlining continues to put certain neighborhoods at a greater disadvantage than others. Earlier studies have found links between neighborhood-related factors, such as socioeconomic status, and disparities in breast cancer survival. Still, a number of these studies lack diversity and had limited information on several important points, such as all the factors that contribute to neighborhood socioeconomic status and whether people received treatment as recommended by National Comprehensive Cancer Network (NCCN) guidelines.
To overcome many of these limitations, in this study, the researchers used a proven tool to measure what they referred to as neighborhood disadvantage in an area that was racially and ethnically diverse. They also had more complete information on treatments, access to care, and cancer characteristics.
The study included 5,027 women diagnosed and treated for stage I to stage IV breast cancer between January 2007 and September 2016 in Broward, Miami-Dade, Monroe, and Palm Beach counties in Florida. This area is home to 6.2 million people, about 30% of Florida’s total population.
The women were treated at a South Florida National Cancer Institute-designated cancer center and a sister safety-net hospital.
Follow-up time was about five years.
The women had an average age of 55.5 years and:
55.8% were Hispanic
27.3% were white
17% were Black
47.7% were married
33.6% were single
16.2% were divorced or separated
Most of the women had private health insurance or Medicaid:
44.4% had private insurance
19.6% had Medicaid
8.3% had Medicare
0.8% had military insurance
5.4% had a type of insurance that wasn’t specified
15.9% had no insurance
The researchers noted how many women had other health conditions, as well as a number of breast cancer risk factors:
7% had diabetes
25.2% had high blood pressure
0.5% had coronary artery disease
69.4% were considered overweight or obese
8% were active smokers and 22.6% were former smokers
28.8% drank alcohol
40.3% used hormonal birth control
16.3% used post-menopausal hormone replacement therapy (HRT)
37.6% had a family history of breast cancer
Among the breast cancers:
60.7% were estrogen receptor-positive and HER2-negative
15.4% were triple negative
11% were estrogen receptor-positive and HER2-positive
7.4% estrogen receptor-negative and HER2-positive
38.5% were stage I
35.7% were stage II
17% were stage III
8.8% were stage IV
Regarding breast cancer treatment, more than 75% of the women received NCCN guideline-recommended treatment:
80.5% had surgery
56.9% received chemotherapy
47.2% received radiation
57.5% received hormonal therapy
78.4% received NCCN guideline-recommended treatment
The researchers’ analysis showed:
Black women were more likely to live in neighborhoods with the highest disadvantage than white women.
Single women were more likely to live in more disadvantaged neighborhoods than married women.
Women living in the most disadvantaged neighborhoods were more likely to be obese and have diabetes than women living in the least disadvantaged neighborhoods.
Women living in the most disadvantaged neighborhoods were more likely to be diagnosed with triple-negative breast cancer and higher stage breast cancer than women living in the least disadvantaged neighborhoods.
Women living in the most disadvantaged neighborhoods were more likely to be diagnosed with stage IV versus stage III breast cancer than women living in the least disadvantaged neighborhoods.
Women living in the most disadvantaged neighborhoods were less likely to receive NCCN guideline-recommended treatment than women living in the least disadvantaged neighborhoods.
Women living in the most disadvantaged neighborhoods were more likely to die from breast cancer than women living in the least disadvantaged neighborhoods. This difference in breast cancer-specific survival remained after the researchers accounted for the characteristics of the cancer, whether the women received NCCN guideline-recommended treatment, and individual socioeconomic status.
Other factors linked to a higher risk of dying from breast cancer were:
being Black
being diagnosed with triple-negative breast cancer
“In this cohort study, a shorter breast cancer-specific survival in women from disadvantaged neighborhoods compared with advantaged neighborhoods was identified, even after controlling for individual-level sociodemographic, comorbidity, breast cancer risk factor[s], access to care, tumor, and National Comprehensive Cancer Network guideline-concordant treatment characteristics,” the researchers wrote. “The findings suggest potential unaccounted mechanisms, including unmeasured social determinants of health and access to care measures.”
What this means for you
For the last four decades, we’ve known that Black women are about 40% more likely to die from breast cancer than white women. Studies have suggested that a number of factors contribute to this disparity, including structural racism in the healthcare system and the biology of the cancer tumor.
The results of this study are very concerning. Still, they do offer more insights into why Black women are more likely to die from breast cancer than white women. Of all the women in this study, Black women were more likely to live in the most low-income neighborhoods that lacked resources.
It’s not clear why living in a neighborhood that lacks economic opportunities and resources is linked to worse breast cancer survival rates. The researchers noted that unmeasured inequities in breast cancer care, including diagnosis delays and not completing treatment, may be possible reasons. For example, women in less affluent areas may have limited access to healthcare and referrals to specialists, which can delay a breast cancer diagnosis and lead to cancer being diagnosed at a later stage, which is linked to worse survival. At the same time, transportation issues and a lack of social support may affect a woman’s ability to complete all the recommended treatments.
There is no quick or easy way to eliminate disparities in breast cancer survival. Other researchers have said we need a better understanding of how the multilayered effects of social and economic disadvantage affect cancer care, as well as more research on the biology of breast cancer tumors in Black women to understand why these tumors are more aggressive.
All people — no matter their race, ethnicity, gender identity, sexual orientation, age, economic status, or other health conditions — deserve the best breast cancer care possible. Differences that affect outcomes, such as access to care, and quality and consistency of care, should be eliminated.
— Last updated on July 3, 2025 at 4:52 PM