Women Living in Isolated White Communities at High Risk of Later Breast Cancer Diagnosis

According to a recent study, women who live in a highly segregated white community are more likely to receive a late-stage diagnosis of breast cancer.

Late-stage breast cancer diagnosis is associated with poorer outcomes, and therefore is an important focus of population health research, which has found racial, ethnic, and geographical disparities in its prevalence across the United States. A recent study published in the International Journal of Environmental Research and Public Health focuses on this phenomenon through the lens of residential isolation.

The place-centered approach to measuring isolation indicates whether a county or other small area is highly segregated by race or ethnicity. A person-centered approach assesses the effect of living in a highly segregated area of one’s own race or ethnicity. The hypersegregated areas observed in this study were mainly white.

Using data on breast cancer cases from the United States Cancer Statistics Database, researchers constructed statistical models to predict the likelihood of late-stage diagnosis. At the individual level, age and race were considered person-level predictors. County-level variables included distance to mammography facilities, uninsured rates, rural population, and measures of isolation using both the area-level isolation index and the person-centered isolation index for each person’s race. The only state-level variable was the presence of a mandate allowing patients to access a specialist without needing a referral.

The study’s main focus was the effect of residential isolation on the likelihood of late-stage breast cancer diagnosis. With the place-centered model, the researchers found a protective effect associated with residence in a segregated Asian community and a detrimental effect associated with living in a segregated white community. Late-stage breast cancer was not predicted by living in highly segregated black or Hispanic communities. At the person-centered level, there was a slight detrimental effect associated with living in a segregated community of one’s own race or ethnicity.

These findings surprised the researchers, as white women overall are at lower risk of late-stage diagnosis but the model indicated that residents of isolated white communities are at higher risk. Additionally, they had anticipated that the social cohesion and support present in isolated communities of one’s own race or ethnicity would motivate cancer screening and result in a decreased risk of late-stage diagnoses, which was contradicted by the results of the person-centered isolation analysis.

According to the researchers, the findings were not attributable to the health disparities observed in poor rural communities, because the most isolated white communities were less likely to be poor. They hypothesized that whites may perceive their own social standing to be shrinking relative to that of minority groups, and this “sense of pessimism can lead to despair and a sense of failure, which can manifest in unhealthy behaviors and a fatalistic attitude.”

In addition, they had found that area-level factors of breast cancer screening, managed care penetration, and mandated specialist access made late-stage diagnosis less likely. At the individual level, the youngest group was at highest risk of late-stage diagnosis, and blacks and Hispanics were more likely to receive such a diagnosis compared with whites.

“These results provide definitive insights into both where and why disparities in late-stage diagnosis of BC [breast cancer] in the US may exist, yet more work is definitely needed in understanding disparities in the incidence of BC and in the incidence of late-stage diagnoses of BC,” the authors concluded.