Breast Cancer in San Francisco: Disentangling Disparities at the Neighborhood Level

Abstract

Background: This study uses a novel geographic approach to summarize the distribution of breast cancer in San Francisco and aims to identify the neighborhoods and racial/ethnic groups that are disproportionately affected by this disease.Methods: Nine geographic groupings were newly defined based on racial/ethnic composition and neighborhood socioeconomic status. Distribution of breast cancer cases from the Greater Bay Area Cancer Registry in these zones were examined. Multivariable logistic regression models were used to determine neighborhood associations with stage IIB+ breast cancer at diagnosis. Cox proportional hazards regression was used to estimate the hazard ratios for all-cause and breast cancer specific mortality.Results: A total of 5,595 invasive primary breast cancers were diagnosed between January 1, 2006 and December 31, 2015. We found neighborhood and racial/ethnic differences in stage of diagnosis, molecular subtype, survival, and mortality. Patients in the Southeast (Bayview/Hunter's Point) and Northeast (Downtown, Civic Center, Chinatown, Nob Hill, Western Addition) areas were more likely to have stage IIB+ breast cancer at diagnosis, and those in the East (North Beach, Financial District, South of Market, Mission Bay, Potrero Hill) and Southeast were more likely to be diagnosed with triple negative breast cancers (TNBC). Compared to other racial/ethnic groups, Blacks/African Americans (B/AA) experienced the greatest disparities in breast cancer related outcomes across geographic areas. Conclusion:San Francisco neighborhoods with lower socioeconomic status and larger minority populations experience worse breast cancer outcomes.

Identification of Distinct Heterogenic Subtypes and Molecular Signatures Associated with African Ancestry in Triple Negative Breast Cancer Using Quantified Genetic Ancestry Models in Admixed Race Populations

“…TNBC, one of the most aggressive forms of breast cancer, has limited treatment options that are ineffective when the cancer is diagnosed at later stages [25][26][27][28][29]. Since AA women tend to be diagnosed at later stages [30,31], at an early age [32][33][34], and suffer higher rates of TNBC, these factors likely contribute to AAs having the highest breast cancer mortality rate among all race groups.…”

Systematic review of neighborhood socioeconomic indices studied across the cancer control continuum

“…Furthermore, the majority of studies did not consider the geographic distribution of the disease to account for the possibility that nearby neighborhoods are more likely to be similar to one another. Recent geospatial cluster analyses show some nSES measures may be more effective than others at explaining the geospatial distribution of cancer within a particular state, 10 and that differences in nSES by neighborhood or geographic location, including living in an urban versus rural area, 101 could affect cancer mortality 102 . This suggests additional studies that consider spatial associations, urbanicity, and evaluate more than one existing nSES index are warranted before particular nSES measures can be recommended as a standard (Table 3).…”

“…Fourth, the majority of studies reviewed were conducted in California, a national leader in the evaluation of nSES and cancer outcomes which can serve as a model for other states 126 . However, in order to move towards standardized nSES index measures, studies across more US states are needed, given that the variation in nSES indices and their associated variables likely differ by geography 102 . Fifth, the majority of reviewed studies utilized State Cancer Registries.…”

“…126 However, in order to move towards standardized nSES index measures, studies across more US states are needed, given that the variation in nSES indices and their associated variables likely differ by geography. 102 Fifth, the majority of reviewed studies utilized State Cancer Registries. Increasing the number of state-specific analyses within and across cancer sites could help clarify the role of nSES in cancer outcomes.…”

How structural racism can kill cancer patients

“…That system has been developed by a team led by Scarlett Lin Gomez, PhD, MPH, a professor of epidemiology and biostatistics at the University of California at San Francisco. One of her recent studies found that patients living in San Francisco neighborhoods with a lower socioeconomic status and larger minority populations had worse outcomes for breast cancer . The study revealed both neighborhood‐level and racial/ethnic differences in the stage of diagnosis, the molecular subtype of the tumor, survival, and mortality.…”