Food security among black breast cancer survivors in Maryland: insights from an online pilot study.

PURPOSE: Food security, and reliable access to nutritious food, is essential for maintaining health yet remains elusive for many, including U.S. patients with breast cancer (BC). Research specifically focusing on public health consequences of food insecurity in BC survivors is limited. We addressed this gap by exploring the relationship between food security and various sociodemographic, clinical, and cancer-related factors among Black BC survivors in Maryland. METHODS: The parent study engaged Black female BC survivors in Maryland through digital campaigns and referrals, achieving 100 completed surveys. Food security was assessed through an online follow-up survey with the six-item short form from U.S. Department of Agriculture (USDA), leading to a binary classification for analysis from raw scores. Statistical analysis involved descriptive analysis and Chi-square tests to explore the relationship between food security status, various BC risk factors, and follow-up survey response status. RESULTS: Of the 31 participants who participated in the follow-up survey, 11 (35.5%) were categorized as having low food security. We observed significant associations between food security status and both income (< $40,000; chi-square p = 0.004) and education levels (high school/GED; chi-square p = 0.004). In comparing respondents to non-respondents, significant differences in employment (p = 0.031) and health insurance status (p = 0.006) were observed. CONCLUSION: Our descriptive findings demonstrate the importance of further studies evaluating food security screenings in Black BC survivors to enable targeted interventions aiming to improve overall health outcomes and equity in cancer survivorship care.

Racial and ethnic disparities in treatment-related heart disease mortality among US breast cancer survivors.

BACKGROUND: Racial and ethnic disparities in heart disease mortality by initial treatment type among breast cancer survivors have not been well described. METHODS: We included 739 557 women diagnosed with first primary invasive breast cancer between 2000 and 2017 (aged 18-84 years, received surgery, survived ≥1 year, followed through 2018) in the Surveillance, Epidemiology, and End Results-18 database. Standardized mortality ratios (SMRs; observed over expected) were calculated by race and ethnicity (non-Hispanic/Latina Asian American, Native Hawaiians, and other Pacific Islanders [AANHPI]; non-Hispanic/Latina Black [Black]; Hispanic/Latina [Latina]; and non-Hispanic/Latina White [White]) and initial treatment (surgery only; chemotherapy with surgery; chemotherapy, radiotherapy, with surgery; and radiotherapy with surgery) compared with the racial- and ethnic-matched general population, and by clinical characteristics. Cumulative heart disease mortality was estimated accounting for competing risks. RESULTS: SMRs were elevated for Black and Latina women treated with surgery only and chemotherapy with surgery (SMR range = 1.15-1.21) and AANHPI women treated with chemotherapy, radiotherapy, with surgery (SMR = 1.29; 95% confidence interval [CI] = 1.11 to 1.48), whereas SMRs were less than 1 for White women (SMR range = 0.70-0.96). SMRs were especially high for women with advanced (regional or distant) stage among Black women for all treatment (range = 1.15-2.89) and for AANHPI and Latina women treated with chemotherapy with surgery (range = 1.28-3.61). Non-White women diagnosed at younger than age 60 years had higher SMRs, as did Black and AANHPI women diagnosed with estrogen receptor-positive breast cancers. Black women had the highest 10-year cumulative risk of heart disease mortality: aged younger than 60 years (Black: 1.78%, 95% CI = 1.63% to 1.94%) compared with White, AANHPI, and Latina women (<1%) and aged 60 years and older (Black: 7.92%, 95% CI = 7.53% to 8.33%) compared with White, AANHPI, and Latina women (range = 3.90%-6.48%). CONCLUSIONS: Our findings illuminated striking racial and ethnic disparities in heart disease mortality among Black, AANHPI, and Latina breast cancer survivors, especially after initial chemotherapy receipt.

County-level geographic disparities in cardiovascular disease mortality among US breast cancer survivors, 2000-2018.

BACKGROUND: Disparities in cardiovascular disease mortality among breast cancer survivors are documented, but geographic factors by county-level socioeconomic status (SES) and rurality are not well described. METHODS: We analyzed 724 518 women diagnosed with localized or regional stage breast cancer between 2000 and 2017 within Surveillance, Epidemiology, and End Results Program-18 with follow-up until 2018. We calculated relative risks (RRs) of cardiovascular disease mortality using Poisson regression, accounting for age- and race-specific rates in the general population, according to county-level quintiles of SES (measured by Yost index), median income, and rurality at breast cancer diagnosis. We also calculated 10-year cumulative mortality risk of cardiovascular disease accounting for competing risks. RESULTS: Cardiovascular disease mortality was 41% higher among breast cancer survivors living in the lowest SES (RR = 1.41, 95% confidence interval [CI] = 1.36 to 1.46, Ptrend < .001) and poorest (RR = 1.41, 95% CI = 1.36 to 1.47, Ptrend < .001) counties compared with the highest SES and wealthiest counties, and 24% higher for most rural relative to most urban counties (RR = 1.24, 95% CI = 1.17 to 1.30, Ptrend < .001). Disparities for the lowest SES relative to highest SES counties were greatest among younger women aged 18-49 years (RR = 2.32, 95% CI = 1.90 to 2.83) and aged 50-59 years (RR = 2.01, 95% CI = 1.77 to 2.28) and within the first 5 years of breast cancer diagnosis (RR = 1.53, 95% CI = 1.44 to 1.64). In absolute terms, however, disparities were widest for women aged 60+ years, with approximately 2% higher 10-year cumulative cardiovascular disease mortality risk in the poorest compared with wealthiest counties. CONCLUSIONS: Geographic factors at breast cancer diagnosis were associated with increased cardiovascular disease mortality risk. Studies with individual- and county-level information are needed to inform public health interventions and reduce disparities among breast cancer survivors.