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- Title
Neighborhood Disadvantage, African Genetic Ancestry, Cancer Subtype, and Mortality Among Breast Cancer Survivors.
- Authors
Iyer, Hari S.; Zeinomar, Nur; Omilian, Angela R.; Perlstein, Marley; Davis, Melissa B.; Omene, Coral O.; Pawlish, Karen; Demissie, Kitaw; Hong, Chi-Chen; Yao, Song; Ambrosone, Christine B.; Bandera, Elisa V.; Qin, Bo
- Abstract
Key Points: Question: What are the relative strengths of associations of African genetic ancestry and neighborhood social environment with outcomes in Black breast cancer survivors? Findings: In this cohort study with 1575 Black female breast cancer survivors aged 20 to 75 years at diagnosis, African genetic ancestry was more strongly associated with tumor subtype than mortality. Associations between neighborhood socioeconomic status and mortality were attenuated following adjustment for potential mediators, including individual socioeconomic factors, lifestyle factors, and comorbidities. Meaning: In this study, African genetic ancestry was more strongly associated with tumor subtype, but social environment was more strongly associated with survival in Black breast cancer survivors. This cohort study examines associations of African genetic ancestry and social environment with tumor subtype and all-cause and breast cancer–specific mortality among Black breast cancer survivors. Importance: Racial disparities in breast cancer (BC) survival arise from multilevel causes, which may exert influence at different stages of BC progression. Clarifying the importance of genetic and social factors could help prioritize interventions. Objective: To jointly examine associations between African genetic ancestry, social environment, and mortality from any cause and BC in Black BC survivors. Design, Setting, and Participants: This population-based cohort study enrolled self-identified Black women aged 20 to 75 years with histologically confirmed BC from June 2005 to May 2019 and followed them up until death or censoring in September 2021. Participants lived in 10 New Jersey counties. Data were analyzed between December 2022 and April 2023. Exposures: A neighborhood socioeconomic status (nSES) index composed of census tract measures (education, income, wealth, employment status, and occupation) was linked to residential addresses at diagnosis. Percentage African ancestry was estimated using the ADMIXTURE program. Main Outcomes and Measures: Sequentially adjusted (age adjusted: age and interview year; fully adjusted: age adjusted with individual SES, lifestyle factors, and comorbidities) logistic regression models were fit to estimate associations with tumor subtypes (estrogen receptor–negative [ER−] vs estrogen receptor–positive [ER+]; triple-negative breast cancer [TNBC] vs luminal A), and Cox models were fit for associations with all-cause mortality (ACM) and breast cancer–specific mortality (BCSM). Models for BCSM were fit using Fine-Gray competing risks models, and robust standard errors were used to account for census tract–level clustering. Results: Among 1575 participants, median (IQR) African ancestry was 85% (76%-90%), and median (IQR) age was 55 (46-63) years. A 10–percentage point increase in African ancestry was associated with higher odds of ER− vs ER+ (adjusted odds ratio [aOR], 1.08; 95% CI, 0.98-1.18) and TNBC vs luminal (aOR, 1.15; 95% CI, 1.02-1.31) tumors, but not with ACM or BCSM. A 1-IQR increase in nSES was associated with lower ACM (adjusted hazard ratio [aHR], 0.76; 95% CI, 0.63-0.93), and the HR for BCSM was less than 1 but not statistically significant (aHR, 0.81; 95% CI, 0.62-1.04) in age-adjusted models, but associations attenuated following further adjustment for potential mediators (individual SES, lifestyles, comorbidities). Conclusions and Relevance: In this cohort study of Black female BC survivors, higher African ancestry was associated with aggressive tumor subtypes. Compared with genetic ancestry, mediating pathways related to social environments may be more important for survival in these patients.
- Subjects
AFRICANS; REPORTING of diseases; STATISTICS; KRUSKAL-Wallis Test; LIFESTYLES; DISEASE progression; CONFIDENCE intervals; BLACK people; RACE; CANCER patients; SURVEYS; SOCIOECONOMIC factors; RESEARCH funding; QUESTIONNAIRES; CHI-squared test; SOCIAL classes; LOGISTIC regression analysis; DATA analysis software; DATA analysis; ODDS ratio; HEALTH equity; BREAST tumors; NEIGHBORHOOD characteristics; LONGITUDINAL method; COMORBIDITY; HORMONE receptor positive breast cancer
- Publication
JAMA Network Open, 2023, Vol 6, Issue 8, pe2331295
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2023.31295