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The cancer divide between Black women and white women in the United States is as entrenched as it is startling. In the 1980s, breast cancer survival rates for the two were nearly identical. But since 1991, as improvements in screening and treatment came into use, the gap has widened, with no signs of abating.

Black women are 40% more likely to die from breast cancer than white women, and one researcher at The University of North Texas Health Science Center at Fort Worth may have uncovered an important piece in decoding this complicated puzzle.

Dr. Justin Luningham, an assistant professor of biostatistics & epidemiology in HSC’s School of Public Health, was the primary investigator of a study recently published in JAMA Network Open, Association of Race and Area Deprivation with Breast Cancer Survival Among Black and White Women in the State of Georgia.

His work shows the economic resources and quality of each patient’s neighborhood impacts Black and white women differently. For years, researchers have linked environmental, socioeconomic, access to health care and many other factors to breast cancer deaths. For the first time, Luningham and his team have shown that, while white women who live in higher-income areas are less likely to die from breast cancer, moving from a poor neighborhood to an affluent one doesn’t have the same effect on Black women.

“We expected to confirm the theory that differences in socioeconomic conditions explained why Black and white women had different mortality outcomes,” Luningham said. “This is actually not what we found.”

For his work, Luningham and his team used a metric called “area deprivation index,” a multidimensional evaluation of socioeconomic conditions down to the zip-code level, which has been linked to numerous health outcomes. They studied 19,580 patients with breast cancer from multiple hospitals across Georgia (primarily in the Atlanta metro area).

“Black women did not see the same rate of improvement in mortality as their area deprivation scores improved,” Luningham said. “In other words, less area deprivation had the expected effect of lower mortality for white breast cancer patients, but it had virtually no effect on mortality for Black breast cancer patients. And compared to white women, Black women had higher mortality at all levels of deprivation—except for the worst-off neighborhoods, where Black and white women had similar levels of mortality. This was true after accounting for a host of other variables, including tumor severity, age at diagnosis and the specific course of treatment that each patient received.”

These findings, Luningham said, suggest that breast cancer mortality in Black women could be associated with additional factors related to living in economically deprived neighborhoods. He believes considering other environmental factors can help inform community-level approaches aimed at reducing these disparities.

Luningham began his work on this study while he was a faculty member at Georgia State University, where he worked with Dr. Ritu Aneja, who was the senior faculty member on the project.

“I continue to collaborate with Justin on multiple projects,” said Aneja, who is now a professor and associate dean for research and innovation at the University of Alabama at Birmingham. “He is an outstanding team player. His multidisciplinary background allows him to successfully bridge ideas across our diverse teams.

“What I particularly love is that he effectively communicates complex statistical concepts/analysis (statistical jargon) in an easily understandable/digestible manner.  He is truly a joy to work with!”

Luningham, who joined HSC in September 2021, said myriad issues could be affecting the gap in breast cancer mortality between Black and white women.

“We still don’t know exactly why Black breast cancer patients have higher mortality rates than white breast cancer patients, but we know it’s complicated,” he said. “The level of deprivation in a patient’s current neighborhood doesn’t account for the type of area the patient lived in for most of her life, and a buildup of chronic stressors or lack of healthy resources early in life can have long-term health implications. This is another reason why stressors faced by Black women, such as experiences with individual or systemic racism, could have an impact on cancer severity later in life.”

To further his research, Luningham said he and his team hope to collect more patient records in other states, including Texas, and examine the various social determinants of health that factor into the gap between Black and white women’s breast cancer outcomes. He and his collaborators also hope to study the potential biological differences in cancer severity across racial and ethnic groups.

“Dr. Luningham’s study highlights why it is so important to understand how structural factors lead to cancer disparities in our communities, particularly among historically disenfranchised people,” said Shafik Dharamsi, dean of HSC’s School of Public Health. “Through the research of our dedicated faculty members like Dr. Luningham, policymakers, clinicians and community organizations are developing a heightened level of awareness of why racialized groups suffer an increased risk of developing and dying from cancer and what can and should be done to address racial disparities in cancer outcomes.”

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