Background: Breast cancer disparities persist globally, with growing evidence implicating neighborhood and built environmental factors in disease outcomes. Methods: This study investigates the associations between neighborhood disadvantage, environmental exposures, and breast tumor characteristics and survival among 3041 stage I–III breast cancer patients treated at the University of Virginia Comprehensive Cancer Center (2014–2024). Neighborhood disadvantage was assessed via the Area Deprivation Index (ADI), while environmental exposures included PM2.5, green space (NDVI), and food indices (modified retail food environment index (mRFEI), retail food activity index (RFAI)). Multivariable regression and Cox models adjusted for demographic, socioeconomic, and clinical covariates were employed. Results: A higher ADI score was associated with aggressive tumor characteristics, including advanced stage (Odds Ratio (OR) = 1.06, 95% Confidence Interval (CI):1.01–1.11), poor differentiation (OR = 1.07, 1.01–1.15), ER-negative status (OR = 1.06, 1.01–1.12), and triple-negative breast cancer (TNBC) (OR = 1.08, 1.02–1.16), as well as younger diagnosis age (β = −0.22, −0.36 to −0.09). PM2.5 exposure was correlated with advanced tumor stage (OR = 1.24, 1.09–1.40 for stage III) but paradoxically predicted improved survival (Hazard Ratio (HR) = 0.71, 0.63–0.82). The food environment indices showed subtype-specific survival benefits: higher mRFEI and RFAI scores were linked to reduced mortality in ER-negative (HR = 0.45, 0.23–0.85 and HR = 0.61, 0.38–0.97) and TNBC (HR = 0.40, 0.18–0.90 and HR = 0.48, 0.26–0.87) patients. NDVI scores exhibited no significant associations. Conclusion: Our findings underscore the dual role of neighborhood disadvantage and the built environmental in breast cancer outcomes. While neighborhood disadvantage and PM2.5 exposure elevate tumor aggressiveness, survival disparities may be mediated by other factors. Improved food environments may enhance survival in aggressive subtypes, highlighting the need for integrated interventions addressing socioeconomic inequities, environmental risks, and nutritional support needs.
背景：乳腺癌差异在全球范围内持续存在，越来越多的证据表明社区和建成环境因素与疾病结局相关。方法：本研究调查了3041名在弗吉尼亚大学综合癌症中心接受治疗的I–III期乳腺癌患者（2014–2024年）中，社区劣势、环境暴露与乳腺肿瘤特征及生存率之间的关联。社区劣势通过地区剥夺指数（ADI）评估，环境暴露包括PM2.5、绿地（归一化植被指数，NDVI）和食物环境指数（改良零售食物环境指数（mRFEI）、零售食物活动指数（RFAI））。研究采用多变量回归和Cox模型，并对人口统计学、社会经济和临床协变量进行了调整。结果：较高的ADI评分与侵袭性肿瘤特征相关，包括晚期分期（比值比（OR）= 1.06，95%置信区间（CI）：1.01–1.11）、低分化（OR = 1.07，1.01–1.15）、雌激素受体阴性状态（OR = 1.06，1.01–1.12）和三阴性乳腺癌（TNBC）（OR = 1.08，1.02–1.16），以及更低的诊断年龄（β = −0.22，−0.36至−0.09）。PM2.5暴露与晚期肿瘤分期相关（III期OR = 1.24，1.09–1.40），但矛盾地预示着生存率改善（风险比（HR）= 0.71，0.63–0.82）。食物环境指数显示出亚型特异性的生存获益：较高的mRFEI和RFAI评分与雌激素受体阴性（HR = 0.45，0.23–0.85和HR = 0.61，0.38–0.97）及TNBC患者（HR = 0.40，0.18–0.90和HR = 0.48，0.26–0.87）的死亡率降低相关。NDVI评分未显示出显著关联。结论：我们的研究结果强调了社区劣势和建成环境在乳腺癌结局中的双重作用。虽然社区劣势和PM2.5暴露增加了肿瘤侵袭性，但生存差异可能由其他因素介导。改善食物环境可能提高侵袭性亚型患者的生存率，这凸显了需要采取综合干预措施，以解决社会经济不平等、环境风险和营养支持需求。
肿瘤(癌症)患者之家