How Do Geographical/Regional Factors Influence Breast Cancer Survival and Incidence among US Women

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Background

Breast Cancer is the second leading cancer among United States (US) women creating a burden of disease that demands research into etiology that can inform prevention and control (NIH National Cancer Institute, 2018). Large, population-based studies surveilling mortality and incidence data are able to identify trends and risk factors that exist among breast cancer cases in the US, and current studies have been providing greater resolution into a variety of these independent variables influencing breast cancer outcomes which makes them invaluable sources of information. While many of these studies have revealed genetic factors that are known risk factors for breast cancer, genetics often do not account for all of the observed variance in breast cancer incidence and survival.

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This role of geography within the United States is especially evident given the incredible variation in the rate of new Breast Cancer cases observed in each state (CDC, 2015). In fact, research has identified many sociodemographic, environmental, and health access related risks which point to the importance of place in the story of breast cancer etiology (REFERENCES). Given that many of these place related risks, such as health access, mammographic screening, environment, etc. can be modified, understanding what factors are indicative of lower survival or increased incidence is a unique opportunity to paint a complete picture of breast cancer etiology and potentially identify opportunities for targeted evidenced-based interventions. For these reasons, considering geography and its relation to breast cancer outcomes is salient. This study seeks to summarize the existing literature on geography and its relation to breast cancer and what mediates that relationship by addressing the following question: Among US women, how do geographical/regional factors influence breast cancer survival and incidence?

Methods

A thorough search of the literature was performed in PubMed, search parameters were set only to include articles published within the last 5 years. Articles were included if they were: 1. Based on United States populations, 2. Directly related to geography/place and factors related to area of living, and 3. Based on incidence and mortality data. Articles were excluded if they were: 1. Based on a population in another country, 2. Were not clearly linked to geography, 3. Were exclusively studies looking at insurance and uptake (particularly among Medicare populations), and 3. Were Interventional studies as the focus of this paper is on epidemiological cross-sectional studies of population level data. The first search combined the terms “geographic*”, “breast cancer”, and “survival.” This search yielded 183 articles, of which 4 met the inclusion criteria. The next search combined the terms “geographic*”, “breast cancer”, “mortality” which only yielded 82 articles, this provided 1 additional article that had not already been identified. The next search combined terms the following geographical terms one at a time “regional”,

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