Latinas with invasive breast cancer living in culturally distinct neighborhoods had improved survival outcomes, according to an observational study of Latinas living in California and Texas.
Previous studies demonstrated that Latinas experience poorer survival outcomes compared with non-Latina white women. However, culturally distinct neighborhoods, or enclaves, have been hypothesized to affect cancer care, with some studies suggesting improved survival — although data of whether neighborhood cultural mix contributes to survival outcomes has been mixed.
The purpose of this study was to determine if living in an ethnic enclave affects survival after a breast cancer diagnosis using consistent measures and analytic methods across 2 different Latina populations in the United States.
“An advanced understanding of the role of enclaves can help to inform neighborhood-level interventions designed to improve survival among Latinas,” the authors wrote.
The study included parallel analyses of cancer registry data from California and Texas between 1996 to 2005, with follow-up through 2014, of Latinas diagnosed with invasive breast cancer. California and Texas were chosen because they have the largest Latina populations of the US. Additional data were used from the 2000 US Census to determine enclaves and neighborhood socioeconomic status (nSES).
Enclaves were protective, as improved survival was associated with living in more culturally distinct enclaves. Latinas who lived in least ethnically distinct enclaves demonstrated significantly poorer all-cause (HR, 1.18; 95% CI, 1.06-1.31 in California; HR, 1.28; 95% CI 1.12-1.47 in Texas, both in lowest quintile) and breast cancer–specific mortality (HR, 1.16; 95% CI, 1.01-1.34 in California; HR, 1.19; 95% CI, 1.00-1.42 in Texas, both in lowest quintile).
Prior studies showed mixed results for whether being foreign-born was associated with survival outcomes, which may be due to differences in methodology. In this study, Latinas who were foreign-born had worse all-cause survival (hazard ratio [HR], 1.13; 95% CI, 1.08-1.19 in California; HR, 1.18; 95% CI, 1.10-1.26 in Texas) and breast cancer-specific survival (HR, 1.19; 95% CI, 1.11-1.26 in California; HR, 1.27; 95% CI, 1.16-1.38 in Texas) compared with US-born Latinas.
All-cause survival and breast cancer-specific survival were independently associated with several factors, which was consistent across both states. Similar to findings from previous studies, lower nSES was associated with poorer all-cause and breast cancer-specific survival in both states.
According to the authors, the results from this study found that low nSES was associated with poorer survival outcomes; however, living within a culturally distinct enclave was associated with protective effects.
This and futures studies could inform the design of interventions within enclaves. “By engaging community members in future research, cancer prevention and control efforts can better leverage local assets, such as ethnic-specific business and social networks, to improve cancer outcomes within enclaves,” the authors wrote.
Shariff-Marco S, Gomez SL, Canchola AJ, et al. Nativity, ethnic enclave residence, and breast cancer survival among Latinas: variations between California and Texas [published online March 17, 2020]. Cancer. doi: 10.1002/cncr.32845