Environmental factors shaping cancer outcomes in Alabama: A scoping review

This scoping review explores how environmental, social, and structural factors influence cancer outcomes in Alabama. Using the Robison and Hudson (2014) survivorship framework, we examined how individual, healthcare provider, and system-level factors influence cancer vulnerability across communities in Alabama.

Following PRISMA-ScR reporting and Joanna Briggs Institute guidelines, we identified and reviewed peer-reviewed studies published between 1995 and 2024 across five databases (PubMed, Embase, Scopus, CINAHL, and PsychINFO). Twenty-one studies met the inclusion criteria and were analyzed across six key areas: food and neighborhood environment, exposure assessment and environmental measurement methods, industrial/toxic releases as exposures, legacy/historical exposures and hematologic outcomes, socioeconomic environment and cancer incidence and racial disparities, community burden, and environmental risk.

Cancer disparities in Alabama are closely tied to geographic, racial, and economic factors. Communities in the Black Belt and industrial corridors face higher exposure to environmental hazards due to historical segregation and industrial development patterns. These exposures are linked to increased rates of colorectal, ovarian, and blood cancers, particularly in areas with persistent poverty and limited access to healthcare.

Cancer outcomes in Alabama cannot be separated from the broader social and environmental context. Understanding these connections is essential for addressing the drivers' underlying health disparities.

Improving cancer survivorship in Alabama requires a comprehensive approach that includes environmental risk assessments, enhanced provider education, and community-driven prevention. These approaches may include local screening initiatives, environmental cleanup, and targeted outreach to high-risk populations.