Institute for Research on Equity & Community Health, Christiana Care Health System, Newark, Delaware, USA.
Helen F. Graham Cancer Center & Research Institute, Christiana Care Health System, Newark, Delaware, USA.
Cancer Med. 2023 May;12(10):11760-11772. doi: 10.1002/cam4.5808. Epub 2023 Mar 14.
Despite similar incidence rates among Black and White women, breast cancer mortality rates are 40% higher among Black women. More than half of the racial difference in breast cancer mortality can be attributed to triple negative breast cancer (TNBC), an aggressive subtype of invasive breast cancer that disproportionately affects Black women. Recent research has implicated neighborhood conditions in the etiology of TNBC. This study investigated the relationship between cumulative neighborhood-level exposures and TNBC risk.
This single-institution retrospective study was conducted on a cohort of 3316 breast cancer cases from New Castle County, Delaware (from 2012 to 2020), an area of the country with elevated TNBC rates. Cases were stratified into TNBC and "Non-TNBC" diagnosis and geocoded by residential address. Neighborhood exposures included census tract-level measures of unhealthy alcohol use, metabolic dysfunction, breastfeeding, and environmental hazards. An overall cumulative risk score was calculated based on tract-level exposures.
Univariate analyses showed each tract-level exposure was associated with greater TNBC odds. In multivariate analyses that controlled for patient-level race and age, tract-level exposures were not associated with TNBC odds. However, in a second multivariate model that included patient-level variables and considered tract-level risk factors as a cumulative exposure risk score, each one unit increase in cumulative exposure was significantly associated with a 10% increase in TNBC odds. Higher cumulative exposure risk scores were found in census tracts with relatively high proportions of Black residents.
Cumulative exposure to neighborhood-level risk factors that disproportionately affect Black communities was associated with greater TNBC risk.
尽管黑人和白人女性的乳腺癌发病率相似，但黑人女性的乳腺癌死亡率却高出 40%。乳腺癌死亡率的种族差异超过一半归因于三阴性乳腺癌（TNBC），这是一种侵袭性乳腺癌亚型，不成比例地影响黑人女性。最近的研究表明，邻里环境条件与 TNBC 的病因有关。本研究调查了累积的邻里环境暴露与 TNBC 风险之间的关系。
这是一项单机构回顾性研究，纳入了来自特拉华州纽卡斯尔县（2012 年至 2020 年）的 3316 例乳腺癌病例，该地区 TNBC 发病率较高。病例根据 TNBC 和“非 TNBC”诊断进行分层，并按居住地址进行地理编码。邻里环境暴露包括基于普查区的衡量指标，包括不健康的饮酒、代谢功能障碍、母乳喂养和环境危害。根据普查区的暴露情况计算总体累积风险评分。
单变量分析显示，每个普查区的暴露情况都与更高的 TNBC 发病几率有关。在控制了患者层面的种族和年龄的多变量分析中，普查区的暴露情况与 TNBC 的发病几率无关。然而，在第二个多变量模型中，纳入了患者层面的变量，并将普查区层面的风险因素视为累积暴露风险评分，发现每个单位的累积暴露增加与 TNBC 发病几率增加 10%显著相关。在黑人居民比例相对较高的普查区，发现了更高的累积暴露风险评分。
累积暴露于不成比例地影响黑人社区的邻里环境风险因素与更高的 TNBC 风险相关。
