Comprehensive Cancer Center, The Ohio State University, Columbus.
Division of Cancer Prevention and Control, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus.
JAMA Netw Open. 2022 Jul 1;5(7):e2220908. doi: 10.1001/jamanetworkopen.2022.20908.
Historical structural racism may be associated with racial, ethnic, and geographic disparities in breast cancer outcomes, but few studies have investigated these potential relationships.
To test associations among historical mortgage lending discrimination (using 1930s Home Owners' Loan Corporation [HOLC] redlining data), race and ethnicity, tumor clinicopathologic features, and survival among women recently diagnosed with breast cancer.
DESIGN, SETTING, AND PARTICIPANTS: This cohort study used a population-based, state cancer registry to analyze breast tumor clinicopathology and breast cancer-specific death among women diagnosed from 2008 to 2017 and followed up through 2019. Participants included all primary, histologically confirmed, invasive breast cancer cases diagnosed among women aged at least 20 years and who resided in a HOLC-graded area of New Jersey. Those missing race and ethnicity data (n = 61) were excluded. Data were analyzed between June and December 2021.
HOLC risk grades of A ("best"), B ("still desirable"), C ("definitely declining"), and D ("hazardous" [ie, redlined area]).
Late stage at diagnosis, high tumor grade, triple-negative subtype (lacking estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2 expression), breast cancer-specific death.
Among a total of 14 964 women with breast cancer, 2689 were Latina, 3506 were non-Latina Black, 7686 were non-Latina White, and 1083 were other races and ethnicities (non-Latina Asian/Pacific Islander/Native American/Alaska Native/Hawaiian or not otherwise specified); there were 1755 breast cancer-specific deaths. Median follow-up time was 5.3 years (95% CI, 5.2-5.3 years) and estimated 5-year breast cancer-specific survival was 88.0% (95% CI, 87.4%-88.6%). Estimated associations between HOLC grade and each breast cancer outcome varied by race and ethnicity; compared with residence in HOLC redlined areas, residence in HOLC areas graded "best" was associated with lower odds of late-stage diagnosis (odds ratio [OR], 0.34 [95% CI, 0.22-0.53]), lower odds of high tumor grade (OR, 0.72 [95% CI, 0.57-0.91]), lower odds of triple-negative subtype (OR, 0.67 [95% CI, 0.47-0.95]), and lower hazard of breast cancer-specific death (hazard ratio, 0.48 [95% CI, 0.35-0.65]), but only among non-Latina White women. There was no evidence supporting associations among non-Latina Black or Latina women.
Compared with redlined areas, current residence in non-redlined areas was associated with more favorable breast cancer outcomes, but only among non-Latina White women. Future studies should examine additional factors to inform how historical structural racism could be associated with beneficial cancer outcomes among privileged racial and ethnic groups.
历史结构性种族主义可能与乳腺癌结局的种族、民族和地理差异有关，但很少有研究调查这些潜在的关系。
测试历史抵押贷款歧视（使用 20 世纪 30 年代房主贷款公司[HOLC]红线数据）、种族和民族、肿瘤临床病理特征与最近诊断为乳腺癌的女性生存之间的关联。
设计、地点和参与者：本队列研究使用基于人群的州癌症登记处，分析了 2008 年至 2017 年诊断并随访至 2019 年的女性的乳腺肿瘤临床病理和乳腺癌特异性死亡。参与者包括所有组织学确诊的原发性浸润性乳腺癌病例，年龄至少 20 岁，居住在新泽西州 HOLC 分级区域。那些缺失种族和民族数据的人（n=61）被排除在外。数据于 2021 年 6 月至 12 月进行分析。
HOLC 风险等级 A（“最佳”）、B（“仍然理想”）、C（“肯定下降”）和 D（“危险”[即红线区域]）。
诊断时的晚期、高肿瘤分级、三阴性亚型（缺乏雌激素受体、孕激素受体和人表皮生长因子受体 2 表达）、乳腺癌特异性死亡。
在总共 14964 名患有乳腺癌的女性中，2689 名是拉丁裔，3506 名是非拉丁裔黑人，7686 名是非拉丁裔白人，1083 名是其他种族和民族（非拉丁裔亚洲/太平洋岛民/本土美国人/阿拉斯加原住民/夏威夷原住民或其他未指明的）；有 1755 例乳腺癌特异性死亡。中位随访时间为 5.3 年（95%CI，5.2-5.3 年），估计 5 年乳腺癌特异性生存率为 88.0%（95%CI，87.4%-88.6%）。HOLC 等级与每种乳腺癌结局之间的估计关联因种族和民族而异；与居住在 HOLC 红线区域相比，居住在 HOLC 评级“最佳”区域与晚期诊断的几率降低相关（比值比[OR]，0.34[95%CI，0.22-0.53]）、肿瘤分级较高的几率降低（OR，0.72[95%CI，0.57-0.91]）、三阴性亚型的几率降低（OR，0.67[95%CI，0.47-0.95]）和乳腺癌特异性死亡的风险降低（风险比，0.48[95%CI，0.35-0.65]），但仅在非拉丁裔白人女性中。没有证据支持非拉丁裔黑人或拉丁裔女性之间存在关联。
与红线区域相比，目前居住在非红线区域与更有利的乳腺癌结局相关，但仅在非拉丁裔白人女性中。未来的研究应检查其他因素，以了解历史结构性种族主义如何与特权种族和族裔群体的有益癌症结局相关。
