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Cancer Epidemiology, Biomarkers & Prevention
Cancer Epidemiology, Biomarkers & Prevention

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Breast Cancer in San Francisco: Disentangling Disparities at the Neighborhood Level

Alice Guan, Daphne Lichtensztajn, Debora Oh, Jennifer Jain, Li Tao, Robert A. Hiatt, Scarlett Lin Gomez and Laura Fejerman; for the San Francisco Cancer Initiative Breast Cancer Task Force
Alice Guan
Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California.
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Daphne Lichtensztajn
Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California.
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  • ORCID record for Daphne Lichtensztajn
Debora Oh
Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California.
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Jennifer Jain
Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California.
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Li Tao
Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California.
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Robert A. Hiatt
Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California.
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  • ORCID record for Robert A. Hiatt
Scarlett Lin Gomez
Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California.
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Laura Fejerman
Division of General Internal Medicine, University of California, San Francisco, San Francisco, California.
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  • For correspondence: Laura.Fejerman@ucsf.edu
DOI: 10.1158/1055-9965.EPI-19-0799 Published December 2019
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Abstract

Background: This study uses a novel geographic approach to summarize the distribution of breast cancer in San Francisco and aims to identify the neighborhoods and racial/ethnic groups that are disproportionately affected by this disease.

Methods: Nine geographic groupings were newly defined on the basis of racial/ethnic composition and neighborhood socioeconomic status. Distribution of breast cancer cases from the Greater Bay Area Cancer Registry in these zones were examined. Multivariable logistic regression models were used to determine neighborhood associations with stage IIB+ breast cancer at diagnosis. Cox proportional hazards regression was used to estimate the hazard ratios for all-cause and breast cancer–specific mortality.

Results: A total of 5,595 invasive primary breast cancers were diagnosed between January 1, 2006 and December 31, 2015. We found neighborhood and racial/ethnic differences in stage of diagnosis, molecular subtype, survival, and mortality. Patients in the Southeast (Bayview/Hunter's Point) and Northeast (Downtown, Civic Center, Chinatown, Nob Hill, Western Addition) areas were more likely to have stage IIB+ breast cancer at diagnosis, and those in the East (North Beach, Financial District, South of Market, Mission Bay, Potrero Hill) and Southeast were more likely to be diagnosed with triple-negative breast cancers (TNBC). Compared with other racial/ethnic groups, Blacks/African Americans (B/AA) experienced the greatest disparities in breast cancer–related outcomes across geographic areas.

Conclusions: San Francisco neighborhoods with lower socioeconomic status and larger minority populations experience worse breast cancer outcomes.

Impact: Our findings, which reveal breast cancer disparities at sub-county geographic levels, have implications for population-level health interventions.

Footnotes

  • Note: Supplementary data for this article are available at Cancer Epidemiology, Biomarkers & Prevention Online (http://cebp.aacrjournals.org/).

  • Cancer Epidemiol Biomarkers Prev 2019;28:1968–76

  • Received July 10, 2019.
  • Revision received August 30, 2019.
  • Accepted September 20, 2019.
  • Published first September 23, 2019.
  • ©2019 American Association for Cancer Research.
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Cancer Epidemiology Biomarkers & Prevention: 28 (12)
December 2019
Volume 28, Issue 12
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Breast Cancer in San Francisco: Disentangling Disparities at the Neighborhood Level
Alice Guan, Daphne Lichtensztajn, Debora Oh, Jennifer Jain, Li Tao, Robert A. Hiatt, Scarlett Lin Gomez and Laura Fejerman for the San Francisco Cancer Initiative Breast Cancer Task Force
Cancer Epidemiol Biomarkers Prev December 1 2019 (28) (12) 1968-1976; DOI: 10.1158/1055-9965.EPI-19-0799

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Breast Cancer in San Francisco: Disentangling Disparities at the Neighborhood Level
Alice Guan, Daphne Lichtensztajn, Debora Oh, Jennifer Jain, Li Tao, Robert A. Hiatt, Scarlett Lin Gomez and Laura Fejerman for the San Francisco Cancer Initiative Breast Cancer Task Force
Cancer Epidemiol Biomarkers Prev December 1 2019 (28) (12) 1968-1976; DOI: 10.1158/1055-9965.EPI-19-0799
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