E61: Neighborhood Disadvantage Predicts Higher Serum Cortisol Levels in Breast Cancer Patients

ePoster Abstract Author(s)

Peter Borowsky, MD (he/him/his)

T-32 Research fellow
University of Miami, United States

Submitter(s)

Peter Borowsky, MD (he/him/his)

T-32 Research fellow
University of Miami, United States

Author(s)

Alexandra E. Hernandez, MD, MPH

Research fellow
University of Miami
Miami, Florida, United States
MR

Molly Ream, MS

Doctoral Student
Sylvester Comprehensive Cancer Center, University of Miami Health System, United States
IA

Ibane Aizpurua, MS

Postdoctoral Scholar
University of the Basque Country, Department of Basic Psychological Processes and their Development, United States
MA

Michael Antoni, PhD

Professor
Sylvester Comprehensive Cancer Center, University of Miami Health System, United States
Neha Goel, MD, MPH

Associate Professor of Surgery
Dewitt Daughtry Department of Surgery, University of Miami, Miami, Florida; Sylvester Comprehensive Cancer Center, Miami, FL
Miami, Florida, United States

Introduction: Neighborhood disadvantage, a consequence of economic and racial segregation, is a structural cause of cancer inequity. In breast cancer patients, neighborhood disadvantage has been associated with shorter breast cancer specific survival even after accounting for individual, tumor, and treatment characteristics, suggesting unaccounted mechanisms by which neighborhood disadvantage may influence survival. Recent literature posits this relationship may be due to activation of physiological stress mechanisms. In this study we evaluate the impact of neighborhood disadvantage on serum cortisol levels in postoperative breast cancer patients.

Methods: Two stress management studies that took place between 1998-2013 enrolled women ≥18 years with stage 0-III breast cancer. Patients provided basic demographic information and afternoon-evening serum cortisol levels at a single timepoint 2-10 weeks following surgery and before initiation of adjuvant therapy. Area Deprivation Index (ADI), a multi-dimensional, validated measure of neighborhood disadvantage was assessed using patients’ home addresses and grouped into binary categories (1-3 for advantaged neighborhoods, 4-10 for disadvantaged neighborhoods). Multivariate regression analyses evaluated the impact of ADI on cortisol levels, controlling for age, stage, surgery type (lumpectomy vs. mastectomy), race and ethnicity, and study cohort.

Results:

403 women (225 from study 1; 178 from study 2) with mean age 52.13 ± 9.74 years were included. 76.7% lived in advantaged neighborhoods. They were non-Hispanic White (54.4%) or Hispanic (33.3%) and had stage 1 (44.0%) or stage 2 (32.3%) disease. On multivariable analysis, women from disadvantaged neighborhoods ADI (4-10) were found to have higher evening cortisol levels than women from advantaged neighborhoods ADI (1-3) (β= 0.163, p= 0.003).

Conclusions:

In this large cross-sectional study we found that women from disadvantaged neighborhoods had higher cortisol levels in the weeks after breast cancer surgery compared to their more advantaged counterparts, irrespective of age, cancer stage, and type of surgery. This association between neighborhood disadvantage and serum cortisol suggests that stress-related neuroendocrine factors may alter the breast cancer pathway and outcome disparities between advantaged and disadvantaged women. Prospective study is needed to determine how these factors may alter tumor biology and breast cancer outcomes.

Learning Objectives:

efficiently and concisely present research findings
thoroughly express research findings using scientific writing format
demonstrate comprehension of topic and addition to current literature