PPS39. Associations between neighborhood disadvantage, neighborhood perceptions, and tumor grade in breast cancer: a prospective cohort study

Friday, March 6, 2026

3:40 PM - 4:10 PM MST

Location: HUB Poster Park - West Hall 1-3

Poster Presenter(s)

Maria A. Sierra, MD, MPH

Research Fellow
University of Miami
Miami, Florida, United States

Co-Author(s)

Peter Borowsky, MD (he/him/his)

Department of Surgery
University of Miami
Miami, Florida, United States
Alexandra E. Hernandez, MD, MPH

Research fellow
University of Miami Miller School of Medicine
Miami, Florida, United States
ER

Elizabeth Reguero Hernandez, MD

University of Miami Miller School of Medicine
Miami, Florida, United States
CT

Chloe Taub, PhD

The University of Alabama at Birmingham
Birmingham, Alabama, United States
Susan B. Kesmodel, MD

Department of Surgery
Univeristy of Miami
Miami, Florida, United States
MA

Michael Antoni, PhD

Professor
University of Miami
Miami, Florida, United States

Primary Author(s)

NG

Neha Goel, MD, MPH

Breast Service, Department of Surgery
Memorial Sloan Kettering Cancer Center
New York, New York, United States

Introduction: Living in neighborhood disadvantage (objective ND) has been associated with more aggressive breast cancer (BCa) biology and shorter recurrence-free survival through upregulation of one’s “fight or flight” sympathetic nervous system (SNS). While the neighborhood in which one lives may be challenging to modify, perceptions that people have of their neighborhood (subjective ND) may be amenable to psychosocial intervention, thus buffering the effect of one’s ND on tumor biology. This study examines the association between objective and modifiable subjective measures of ND and tumor grade.

Methods: From 2019-2025, women diagnosed with stage I-III BCa were prospectively enrolled at an NCI-designated cancer center and sister safety-net hospital. Patients completed surveys which captured sociodemographic data and subjective ND (Neighborhood Social Environment Adversity Survey [NSEAS]). Objective ND was measured using the Area Deprivation Index (ADI) from residential addresses (1=most advantaged, 10=most disadvantaged). Clinical pathologic data was obtained from the electronic medical record. Logistic regression analyzed the association between ND (NSEAS, ADI) and tumor grade (low [well/moderately differentiated] vs. high [poorly differentiated]), controlling for age, race/ethnicity, insurance, and prognostic stage.

Results: 632 women were included with a mean age of 57. Among those with high-grade disease, 13.1% were non-Hispanic White, 20.7% non-Hispanic Black, and 63.1% Hispanic. Extreme neighborhood disadvantage (ADI ≥90th percentile) was observed in 9.3% of patients with low-grade and 16.0% with high-grade disease. On multivariable analysis, both extreme objective ND and poorer perceived neighborhood safety (crime, violence) were associated with increased odds of poorly differentiated BCa (OR 2.26, 95% CI 1.10–4.63, p = 0.026; OR 1.22, 95% CI 1.03–1.45, p = 0.024, respectively).

Conclusions: This prospective cohort study demonstrates that both objective and subjective measures of ND relate to BCa tumor biology. These findings lay the foundation for future studies that evaluate how one’s perception of their neighborhood can serve as a potential modifiable target for future interventions that reduce SNS activity and reverse aggressive biology amongst those living in ND.

Learning Objectives:

Identify how both objective (ADI) and subjective (NSEAS) measures of neighborhood disadvantage relate to breast cancer tumor biology.
Determine the associations between neighborhood disadvantage indicators and breast cancer tumor grade using adjusted multivariable analysis.
Identify potential structural and psychosocial pathways through which neighborhood disadvantage may influence tumor biology and opportunities for intervention.