社区集中劣势与全美黑人女性研究中乳腺癌复发或死亡风险

Purpose: US Black women with breast cancer experience higher rates of recurrence and disease-specific mortality. [1] We previously found that Black breast cancer patients living in areas of high neighborhood concentrated disadvantage (nDIS) have poorer breast cancer-specific survival when compared to those living in areas with low nDIS. [2] The present analysis incorporates recurrence events to assess the association of nDIS with disease-free survival. We hypothesize that the association will be weaker than with mortality, an outcome more clearly influenced by neighborhood-level factors such as access to care. Methods: We included 2,290 Black Women's Health Study (BWHS) participants diagnosed with incident breast cancer (stages I-III). Recurrence was defined as an invasive cancer in the ipsilateral breast or in a common metastatic site (lung, liver, brain, or bone) occurring more than four months after the initial breast cancer diagnosis. Medical records were reviewed to distinguish true metastases from new primary tumors. Data on death and cause of death were determined from the National Death Index. We used geocoded participant addresses from the time of breast cancer diagnosis in conjunction with US Census Bureau and American Community Survey data to calculate nDIS. Hazard ratios (HRs) and 95% confidence intervals (CI) were estimated from multivariable Cox proportional hazards models with control for tumor characteristics, treatments, education, insurance, and lifestyle factors. Results: There were 399 poor breast cancer outcomes (recurrence or death) among 2,290 breast cancer cases followed for a median of 10.5 years. Compared to women in the lowest quartile of nDIS, HRs for a subsequent breast cancer outcome were 1.00 (95% CI 0.93-1.89), 1.19 (95% CI 0.89-1.59) and 1.29 (95% CI 0.94-1.75), for quartiles 2, 3, and 4, respectively. A statistically significant trend was observed across quartiles ( p- trend=0.03), indicating increasing risk of poor outcomes with greater neighborhood disadvantage. Conclusions: Breast cancer survivors living in the most disadvantaged neighborhoods were estimated to have 1.29 times the rate of breast cancer death or recurrence compared to those living in the most advantaged neighborhoods. While our findings were statistically significant, the magnitude was lower than the 1.47-fold increase in mortality rate that we previously observed in the same study population, suggesting that factors captured by nDIS may be more important to survival than to recurrence. [1] Black Women Have Higher Risk of Recurrence Than Other Ethnicities. Oncology Times 41(1):p 24, January 5, 2019. | DOI: 10.1097/01.COT.0000552839.22529.72[2] Holder EX, Barnard ME, Xu NN, Barber LE, Palmer JR. Neighborhood Disadvantage, Individual Experiences of Racism, and Breast Cancer Survival. JAMA Netw Open. 2025;8(4):e253807. doi:10.1001/jamanetworkopen.2025.3807