Living in a Disadvantaged NYC Neighborhood Is Associated With Poorly Differentiated Breast Cancer and Shorter Breast Cancer-specific Survival.

Abstract

To evaluate the association between living in disadvantaged neighborhoods in New York City (NYC) with tumor grade, a clinical proxy for proliferation and tumor aggressiveness, and breast cancer-specific survival (BCSS). Neighborhood disadvantage (ND) is associated with shorter BCSS, independent of individual-level, tumor, and treatment characteristics, highlighting unmeasured factors associated with this survival disparity. Women with stage I to III breast cancer (BCa) living in NYC treated at Memorial Sloan Kettering Cancer Center from 2013 to 2024 were included. ND was stratified using the Area Deprivation Index (ADI). The median ADI for the cohort was 3 and was used as the cutoff between neighborhood advantage (NA, ADI 1-3) and ND (ADI 4-10). Multivariable logistic regression and Cox proportional hazards modeling, controlling for individual, tumor, and treatment factors, were used to determine the association between ND and tumor grade and BCSS, respectively. Five thousand four hundred fifty-two women with BCa were included. Three thousand four hundred seventy-nine (64%) lived in NA and 1973 (36%) in ND. On multivariable analysis, ND had higher odds of poorly versus well/moderately differentiated tumors (adjusted odds ratio: 1.23, CI: 1.03-1.48), independent of age, race/ethnicity, insurance, body mass index, smoking/alcohol, stage, and subtype. ND was also associated with shorter BCSS (adjusted hazard ratio: 1.56, CI: 1.05-2.38). Women living in ND in NYC were more likely to present with poorly differentiated tumors and have shorter BCSS. These findings merit further inquiry and lay the foundation for future translational studies to externally validate the mechanisms by which ND "gets under the skin" to impact aggressive BCa tumor biology, and ultimately survival.