Racialized Economic Segregation, Treatment, and Outcomes in Women with Triple-Negative Breast Cancer

Area of Science:

• Oncology
• Public Health
• Sociology

Background:

• Previous research indicated disparities in triple-negative breast cancer (TNBC) treatment and mortality between non-Hispanic Black (NHB) and non-Hispanic White (NHW) women.
• The influence of residential segregation on TNBC outcomes remained unexamined.

Purpose of the Study:

• To investigate the impact of residential segregation on the treatment and outcomes of TNBC in NHB and NHW women.

Main Methods:

• Utilized the Surveillance, Epidemiology, and End Results (SEER) dataset for TNBC patients diagnosed between 2010-2015, with follow-up through 2016.
• Measured county-level racialized economic segregation using the index of concentration at the extremes.
• Employed multilevel Cox and logistic regression models to analyze mortality and diagnosis stage, accounting for county-level clustering.

Main Results:

• Patients in the most deprived counties (high concentration of low-income NHB residents) faced significantly higher risks of breast cancer-specific mortality (HR=1.14), overall mortality (HR=1.15), and late-stage diagnosis (OR=1.15) compared to those in the most privileged counties (high concentration of high-income NHW residents).
• Residential segregation explained a substantial portion of excess risks for mortality and late-stage diagnosis in NHB patients.
• No significant association was found between residential segregation and treatment received.

Conclusions:

• Living in deprived neighborhoods is linked to reduced early detection and survival rates for TNBC patients.
• Residential segregation contributes to the observed disparities in TNBC outcomes between NHB and NHW women.
• Targeted breast cancer screening in predominantly low-income NHB neighborhoods is crucial, and further research should explore the mechanisms connecting segregation to TNBC prognosis.