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As healthcare providers, our goal is to provide the best quality, equitable, and compassionate care to all our patients. Implicit bias and segregation in all forms can impact treatment.

Often when patients step through the clinic door, providers are unaware of the biases that may hinder optimum treatments, such as racial and socioeconomic disparities. Not often considered in the clinic is the relationship between the area of residential living and how this interferes with care for breast cancer patients.

A recent study in the is one of the first papers to try to fully understand how residential segregation impacts cancer care for breast cancer patients.

Residential segregation can be associated with disparities for access to cancer care, which can directly (or indirectly) lead to lower health-related quality of life and worse mortality rates. Redlining is a term for mortgage lending bias based on property location, which in turn increases segregation and can potentially lead to social discrimination and inequalities that can ultimately affect all portions of a patient's life, including cancer care and delivery.

The publication by Beyer et al. highlights that women in more redlined areas have worse all-cause and breast cancer-specific survival. Surprisingly, the women who were most affected were without comorbid conditions. This is striking, since one would usually assume that those with more medical conditions have worse outcomes. The study thus directly challenges that assumption and suggests that location of residency may be a more important factor to consider.

Another finding suggested that Black race was non-significant in this context and that location was more of a factor in terms of worse outcome, compared with race as had been indicated in prior SEER analysis reports. As more and more literature is coming out to acknowledge cancer disparities, it is evident that the answer is not as simple as one or two factors such as race, insurance type, or perhaps even residential location.

It is quite possible that survival rates could depend on a combination of many factors working together, from direct cancer care to indirect factors such as race, insurance type, area of residency, amount of financial toxicity, and so on.

The growing literature of identifying factors outside of direct cancer care is very reassuring to see, and we are optimistic that with further research and time, once we identify the multiple factors that impact cancer care, a systematic approach can be taken to mitigate poor outcomes in not only breast cancer patients but also for other cancer patients as well.

Arpan A. Patel, MD, is assistant professor in the Department of Medicine, Hematology/Oncology, at the University of Rochester Wilmot Cancer Center in New York.

Read the study here and an interview about it here.