Evidence map›Paper›PMID 40906319›Full record

ArticleCancer causes & control : CCC2025

County-level socioeconomic status, rurality, and second primary cancer risk among breast cancer survivors in the United States.

Katherine Ho, Carolyn Brandt, Jessica Li, Geetanjali Datta, Justin X Moore, Lene H S Veiga, Gretchen L Gierach, Amy Berrington de González, Jacqueline B Vo, Cody Ramin

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Article in Cancer causes & control : CCC, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

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0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

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3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

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4 · The record

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5 · Who and what money

Authors and funding

10 authors.

Katherine Ho *Division of Population Sciences, Cedars-Sinai Cancer Center, 6500 Wilshire Blvd, Los Angeles, CA, 90048, USA.
Carolyn Brandt *Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA.
Jessica LiDivision of Population Sciences, Cedars-Sinai Cancer Center, 6500 Wilshire Blvd, Los Angeles, CA, 90048, USA.
Geetanjali DattaDivision of Population Sciences, Cedars-Sinai Cancer Center, 6500 Wilshire Blvd, Los Angeles, CA, 90048, USA.
Justin X MooreCommunity Impact Office, Markey Cancer Center, University of Kentucky, Lexington, KY, USA.
Lene H S VeigaDivision of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA.
Gretchen L GierachDivision of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA.
Amy Berrington de GonzálezDivision of Genetics and Epidemiology, The Institute of Cancer Research, London, UK.
Jacqueline B VoDivision of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA.
Cody RaminDivision of Population Sciences, Cedars-Sinai Cancer Center, 6500 Wilshire Blvd, Los Angeles, CA, 90048, USA. Cody.Ramin@cshs.org.

Funding

INSTITUTIONAL RESEARCH CANCER EPIDEMIOLOGY FELLOWSHIPT32CA009314 · NCI · JOHNS HOPKINS UNIVERSITY · PI Corinne E. Joshu, Meghan Bridgid Moran · 1985 to 2026
$11.2M
NCI NIH HHS T32 CA009314
6 · The paper itself

Abstract

backgroundBreast cancer survivors have an increased risk of second primary cancers (SPCs), the role of county-level socioeconomic status and rurality-factors that may influence access to treatment, surveillance, and preventive care-remains understudied.

methodsWe identified 721,957 women with localized/regional first primary breast cancer who survived ≥ 1 year in 17 Surveillance, Epidemiology, and End Results registries (2000-2018). We used Cox regression to assess associations between county-level median household income (proxy for socioeconomic status), rurality, and their joint effects on invasive SPC risk, adjusting for demographic and clinical factors. We examined risk for all SPCs, non-breast SPCs, and the three most common SPC sites (breast, lung/bronchus, colorectal). Models were further stratified by index breast cancer characteristics.

resultsDuring 6.1 median years of follow-up, 65,954 survivors developed an SPC (42,400 non-breast; 23,554 breast, 8,338 lung/bronchus, 5,442 colorectal). Survivors from lower-income counties had higher SPC risk (< $50,000 vs. ≥ $75,000: HR = 1.07, 95% CI = 1.04-1.10), driven by lung/bronchus (HR = 1.32, 95% CI = 1.23-1.42) and colorectal cancers (HR = 1.19, 95% CI = 1.09-1.31). Lung/bronchus cancer risk was stronger among younger (age < 50: HR = 1.95, 95% CI = 1.59-2.39, age ≥ 50: HR = 1.20, 95% CI = 1.12-1.28; p interaction < 0.001) and Estrogen Receptor (ER)-negative survivors (ER negative: HR = 1.50, 95% CI = 1.31-1.72; ER positive: HR = 1.21, 95% CI = 1.12-1.30; p interaction = 0.02). Survivors from rural counties had higher SPC risk compared with most urban counties (HR range:1.07-1.12), especially for lung/bronchus cancer in younger (age < 50: HR = 1.66, 95% CI = 1.34-2.05, age ≥ 50: HR = 1.13, 95% CI = 1.06-1.21; p interaction = 0.001) and ER-negative survivors (ER negative: HR = 1.45, 95% CI = 1.26-1.67; ER positive: HR = 1.11, 95% CI = 1.03-1.20; p interaction = 0.001). Survivors in rural/lower-income counties had the highest SPC risk compared with urban/higher-income counties (HR-range: 1.20-1.23), particularly for lung/bronchus cancer (HR = 1.57, 95% CI = 1.10-2.23).

conclusionStudies are needed to understand factors driving the impact of socioeconomic status and rurality (e.g., access to care) on SPC risk to inform preventive strategies for breast cancer survivors.

Indexed as

Breast NeoplasmsCancer SurvivorsNeoplasms, Second PrimaryRural PopulationSocial ClassAdultAgedFemaleFollow-Up StudiesHumansMiddle AgedRisk FactorsSEER ProgramUnited StatesBreast cancerRuralitySecond primary cancerSocioeconomic statusSurvivorship

Identifiers

PMID40906319
PMCPMC12630244

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.