Breast Cancer in Your Neighborhood?

In breast cancer, women who live in neighborhoods with the highest 20 percent of education and income are twice as likely to be diagnosed with that disease, a 2017 studyfound. That seemed to confirm reports of breast-cancer hot spots in some of America's wealthiest areas, leading the government and others to spend tens of millions of dollars to find out why. Those studies came up empty: they found no association between rates of breast cancer and proximity to a hazardous waste site or pesticide exposure, for instance.

Wealthier, better educated women are, however, more connected to the health care system and therefore get more mammograms, breast ultrasounds, and MRIs. The more scrutiny, the more likely that harmless cases of breast cancer are found. (The idea of "harmless" breast cancer sounds like an oxymoron, but an estimated one-half of breast cancers detected by screening would never cause problems even if undetected and untreated.)

Breast tumors found by imaging are much more likely to be harmless than those discovered by women or their physicians finding a breast lump. Income and education are therefore less likely to be a true risk factor for breast cancer and more likely to be a "risk factor" for undergoing screening. If poorer, less educated women were screened for breast cancer at the same rate as wealthier, better educated women, the socioeconomic risk factor would likely vanish.

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