ASPO Abstracts

Neighborhood socioeconomic status and breast cancer subtypes among Black women: findings from the Women's Circle of Health Study

Authors: Qin B, Llanos AAM, Babel R, Plascak JJ, Pawlish K, Diez Roux AV, Ambrosone CB, Demissie K, Hong CC, Bandera EV

Category: Cancer Health Disparities
Conference Year: 2020

Abstract Body:
Background: Many studies have examined individual-level socioeconomic status (SES) as a major social determinant of more aggressive breast tumor phenotypes. However, the impact of neighborhood-level SES (nSES) on breast cancer is not well understood, particularly among Blacks, who are more likely to develop the aggressive triple-negative breast cancer (TNBC). Objective: To evaluate the impact of nSES on breast cancer subtypes among Black women with breast cancer. Methods: We evaluated the association of interest among 1,220 Black women with invasive breast cancer from 2006 to 2018 enrolled from 10 counties of New Jersey in the Women's Circle of Health Study (WCHS). Residential address at diagnosis was geocoded to the census tract-level. Neighborhood SES was measured using the NCI’s census tract-level SES index, a time-dependent score constructed by a factor analysis of seven variables measuring different aspects of census tract SES. In a case-only analysis, we used multilevel multinomial logistic regressions to estimate nSES in relation to breast cancer subtype (TNBC, HER2-enriched, Luminal B vs. Luminal A). Models were adjusted for individual-level SES variables, BMI and reproductive factors, and census tract-level percentage of Black residents. We also tested whether the associations were modified by percentage of Black residents. Results: Higher nSES was found to predict a lower risk of TNBC. Compared to tertile 1 (lowest nSES score), the odds ratio (OR) was 0.91 (95% CI: 0.65, 1.29) for tertile 2 and 0.52 (95% CI: 0.34, 0.79) for tertile 3 (p-trend: 0.001). Higher nSES was borderline significantly associated with a lower risk of Luminal B. The inverse association between nSES and TNBC was observed only among Black women living in census tracts with lower proportion of Black residents (p-for-interaction=0.08). Compared to the lowest nSES tertile, OR was 0.38 (95% CI: 0.21, 0.68) for the highest tertile (p-trend: <0.001). Conclusion: Neighborhood socioeconomic environment may influence the development of TNBC among Black women, which might be buffered by some contextual factors in areas with more Black residents.

Keywords: neighborhood, breast cancer subtypes, triple-negative breast cancer, Blacks, socioeconomic environment