Persistent Poverty Increases Breast Cancer Mortality Risk by 56%

poor neighborhood © Mulderphoto - stock.adobe.com

Breast cancer patients living in persistent poverty-stricken neighborhoods have worse tumor characteristics, surgical management and mortality than patients living outside these zones, according to the results of a study published in JAMA Network Open last week.

Persistently impoverished neighborhoods are classified as areas where 20% of the population have lived below the poverty line for at least 30 years. These areas are characterized by systemic and structural decay where basic necessities like education and healthcare services are scarce. This ultimately leads to generational poverty.

A team of investigators led by J.C. Chen, M.D., from the Division of Surgical Oncology at The Ohio State University used the Surveillance, Epidemiology, and End Results (SEER) Program, which currently represents about half of the United States cancer population.

Chen’s team identified 312,145 patients and 20,007 were women ages 18 and older who were diagnosed with stage I to III breast cancer between 2010 and 2018 and living in persistently impoverished neighborhoods. Of these women, 36% had grade 3 cancer and 15% had triple negative breast cancer. Researchers also found that patients living in these areas [10,590 of 20,007] (52.9%) were less likely to undergo breast reconstruction when compared to women living outside these neighborhoods [124,659 of 292,130] (42.7%).

There were a greater number of Black (43.7%) patients living in impoverished areas when compared to non-impoverished areas (10.1%). About half (52%) of people living in impoverished areas were White.

While 42.5% of patients living in persistent poverty were likely to receive chemotherapy and 45% were likely undergo mastectomies, just over half (52%) were likely to have breast reconstruction surgery.

Chen’s team believes chronic stress is a contributing factor to increased and more aggressive breast cancer cases.

“One plausible mechanism involves the chronic activation of the hypothalamic-pituitary-adrenal axis and the sympathetic-adrenal-medullary pathway, often measured through allostatic load,” the team writes.

Allostatic load is the measure of chronic stress on the body. Allostatic overload occurs when a person can no longer cope with environmental challenges. It is measured by looking at biomarkers connected to stress physiology like seated systolic and diastolic blood pressure, total cholesterol and glycosylated hemoglobin, according to a study published in Psychotherapy and Psychosomatics.

“Existing studies have noted associations between allostatic load, neighborhood level racialized economic segregation, and mortality among patients with cancer. However, studies evaluating the role of persistent poverty on allostatic load are needed,” the team writes.