Urban Neighborhood and Residential Factors Associated with Breast Cancer in African American Women: a Systematic Review

Abstract

Residential characteristics in urban neighborhoods impact health and might be important factors contributing to health disparities, especially in the African American population. The purpose of this systematic review is to understand the relationship between urban neighborhood and residential factors and breast cancer incidence and prognosis in African American women. Using PubMed and Web of Science, the existing literature was reviewed. Observational, cross-sectional, cohort, and prospective studies until February 2017 were examined. Studies including populations of African American women, setting in "urban" areas, and a measure of a neighborhood or residential factor were reviewed. Four parameters related to neighborhood or residential factors were extracted including: neighborhood socioeconomic status (nSES), residential segregation, spatial access to mammography, and residential pollution. Our analysis showed that African American women living in low nSES have greater odds of late stage diagnosis and mortality. Furthermore, African American women living in segregated areas (higher percentage of Blacks) have higher odds of late stage diagnosis and mortality compared to White and Hispanic women living in less segregated areas (lower percentage of Blacks). Late stage diagnosis was also shown to be significantly higher in areas with poor mammography access and areas with higher Black residential segregation. Lastly, residential pollution did not affect breast cancer risk in African American women. Overall, this systematic review provides a qualitative synthesis of major neighborhood and residential factors on breast cancer outcomes in African American women.

Cancer Stage at Diagnosis, Historical Redlining, and Current Neighborhood Characteristics: Breast, Cervical, Lung, and Colorectal Cancers, Massachusetts, 2001–2015

“…Three lines of evidence lend credibility to our findings. First, among the small number of studies examining risk of late stage at diagnosis for cancer in relation to adverse racial segregation, elevated risk has been reported for breast, colorectal, and lung cancer ( 19 , 20 , 42 , 43 ). Second, the relatively modest associations observed between current adverse CT characteristics and late stage at cancer diagnosis is compatible with evidence indicating 1) effective program implementation by Massachusetts initiatives to increase cancer screening for cervical, breast, and colorectal cancer and to reduce racial/ethnic health inequities in such screening ( 25 , 27 , 44 ), coupled with 2) policies to increase access to health-care insurance in Massachusetts, which have rendered Massachusetts the state with the lowest proportion of persons uninsured since 2006 ( 44–47 )—and thus an apt locale in which to examine HOLC effects independent of insurance status.…”

Association between Neighborhood Social Deprivation and Stage at Diagnosis among Breast Cancer Patients in South Carolina

“…Specifically, the social deprivation index (SDI) is a composite variable that is used to characterize social factors that are important to health care and clinical outcomes [10,11]. Although previous studies have shown that specific neighborhood factors such as low socioeconomic status and residence in segregated areas are associated with breast cancer stage at diagnosis and breast cancer mortality [12], there is a paucity of empirical data on the relationships between neighborhood deprivation score and stage of diagnosis for breast cancer. Empirical data on the relationship between neighborhood deprivation and breast cancer stage can inform decisions about geographic areas that should be prioritized for greater cancer control services and community outreach [4,[7][8][9]13].…”

Association of Social Determinants and Tumor Biology With Racial Disparity in Survival From Early-Stage, Hormone-Dependent Breast Cancer

“…Racial disparities in breast cancer outcomes are rooted in a wide range of adverse social determinants of health and a higher rate of biologically aggressive tumors among Black women . Contextual factors that encompass societal conditions and policy decisions, neighborhood disadvantage, and individual socioeconomic deprivation all contribute to the racial disparity in breast cancer mortality . Emerging evidence indicates that social determinants can also influence tumor biology …”