Research has shown that women with breast cancer who live in socioeconomically disadvantaged neighborhoods have poorer outcomes. This is often true even after studies control for other factors such as patient characteristics, disease characteristics, and guideline-compliant treatment.
“This persistent disparity suggests unaccounted mechanisms by which neighborhood disadvantage ‘gets under the skin’ to impact to shorter breast cancer survival,” according to Neha Goel, of the University of Miami Miller School of Medicine/Sylvester Comprehensive Cancer Center in Florida.
To elucidate possible mechanisms, researchers conducted a study to evaluate cortisol levels and anxiety levels in a population of women with breast cancer from both advantaged and disadvantaged neighborhoods. They presented their results at the 2022 American Society of Clinical Oncology (ASCO) Annual Meeting.
The study enrolled 240 women with breast cancer with an average age of 50.4 years. Most of the women (63.6%) were non-Hispanic white, and most had stage 1 (37.8%) or 2 (38.2%) disease. Most (77.8%) lived in advantaged neighborhoods, as evaluated by the Area Deprivation Index.
The participants provided a baseline sample of serum cortisol sample in the evening and completed the Hamilton Anxiety Rating Scale.
Overall, 46.8% of the women had clinically significant anxiety symptoms, according to the rating scale. Women from disadvantaged neighborhoods were nearly two times as likely to have clinically significant anxiety symptoms compared to women from advantaged neighborhoods, even after the researchers accounted for age, stage of cancer, and type of surgery. Women from disadvantaged neighborhoods also had higher levels of cortisol than women from advantaged neighborhoods, even after the researchers controlled for those other characteristics.
The authors concluded that neighborhood advantage versus disadvantage is significantly associated with levels of cortisol and clinical anxiety. They recommended that future research focus on stress and anxiety as potential mechanisms that affect breast cancer outcomes by socioeconomic subpopulation.