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. 2019 Feb 18:7:18.
doi: 10.3389/fpubh.2019.00018. eCollection 2019.

Neighborhood Social Determinants of Triple Negative Breast Cancer

Fokhrul Hossain  1 , Denise Danos  1 , Om Prakash  1 , Aubrey Gilliland  2 , Tekeda F Ferguson  2 , Neal Simonsen  3 , Claudia Leonardi  2 , Qingzhao Yu  2 , Xiao-Cheng Wu  2 , Lucio Miele  1 , Richard Scribner  2
Affiliations

Neighborhood Social Determinants of Triple Negative Breast Cancer

Fokhrul Hossain et al. Front Public Health. .

Abstract

Triple Negative Breast Cancer (TNBC) is an aggressive, heterogeneous subtype of breast cancer, which is more frequently diagnosed in African American (AA) women than in European American (EA) women. The purpose of this study is to investigate the role of social determinants in racial disparities in TNBC. Data on Louisiana TNBC patients diagnosed in 2010-2012 were collected and geocoded to census tract of residence at diagnosis by the Louisiana Tumor Registry. Using multilevel statistical models, we analyzed the role of neighborhood concentrated disadvantage index (CDI), a robust measure of physical and social environment, in racial disparities in TNBC incidence, stage at diagnosis, and stage-specific survival for the study population. Controlling for age, we found that AA women had a 2.21 times the incidence of TNBC incidence compared to EA women. Interestingly, the incidence of TNBC was independent of neighborhood CDI and adjusting for neighborhood environment did not impact the observed racial disparity. AA women were more likely to be diagnosed at later stages and CDI was associated with more advanced stages of TNBC at diagnosis. CDI was also significantly associated with poorer stage-specific survival. Overall, our results suggest that neighborhood disadvantage contributes to racial disparities in stage at diagnosis and survival among TNBC patients, but not to disparities in incidence of the disease. Further research is needed to determine the mechanisms through which social determinants affect the promotion and progression of this disease and guide efforts to improve overall survival.

Keywords: SEER database; concentrated disadvantage; multi-level modeling; racial disparity; socioeconomic factors; triple negative breast cancer.

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Figures

Figure 1
Figure 1
Age-specific unadjusted incidence of triple-negative breast cancer among females by race, Louisiana 2010–2012.
Figure 2
Figure 2
Distribution of concentrated disadvantage index among female triple negative breast cancer patients by race, Louisiana 2010–2012. CDI is a sample-based index, where scores have a mean of 0 and a standard deviation of 1. Therefore, a single unit increase in CDI represents a one standard deviation increase in neighborhood disadvantage.
Figure 3
Figure 3
Kaplan-Meier SEER stage-specific survival plots of triple negative breast cancer patients by race, Louisiana 2010–2012.
See this image and copyright information in PMC

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