New research published today in JAMA Network Open connects multiple residential factors generally associated with financial strain, such as high housing costs and crowded households, to worse overall outcomes among breast cancer survivors. Led by investigators at VCU Massey Comprehensive Cancer Center, the findings could help inform innovative strategies to increase health care access and ease economic stress for a variety of patients in need.
“Our research could provide clues for future policy interventions to promote improved breast cancer survivorship for all patients, regardless of where or how they live,” said study lead author Joseph Boyle, Ph.D. , a research instructor in the Department of Family Medicine and Population Health at the VCU School of Medicine.
A large focus of clinical research is shifting toward the comprehensive consideration of what people encounter in their daily life, including the neighborhoods they live in, and how that can affect health outcomes. In collaboration with researchers from the University of Virginia Comprehensive Cancer Center and the University of Maryland, this initiative set out to fully explore the neighborhood exposome—all of the neighborhood-level factors a person is exposed to—in an effort to gain precise insights on its relationship to breast cancer survivorship.
“The innovative aspect of this work has to do with better understanding how the totality of the environment in which one lives impacts their health and translates to different outcomes among cancer survivors,” said study senior author Bernard Fuemmeler, Ph.D., MPH , associate director of population sciences and Gordon D. Ginder, M.D. Chair in Cancer Research at Massey. “By discovering which aspects of the environment influence cancer outcomes, we hope to be better prepared to intervene earlier with high-risk patients based on both their health risks and their social risks too.”
Using geographic information systems methods and machine learning statistical approaches, the research team identified four specific variables—from a set of more than 5,500 unique neighborhood-level variables—that were statistically associated with shorter breast cancer survival among thousands of women diagnosed with breast cancer in Virginia:
One common theme interwoven between these different neighborhood-level variables: Financial toxicity and stress.
A cancer diagnosis can create a significant economic burden for patients, including causing possible job loss due to the intense commitment of treatment, as well as financial constraints in efforts to pay for those treatments.
Boyle added that many neighborhoods in the United States that exhibit some of these stressors, including high housing costs among low-income populations or crowded households, are simultaneously more likely to have less reliable transportation methods or greater environmental hazards, which also drive worse breast cancer outcomes, among other health conditions.
“We want to understand how some of these factors are driving survival-related outcomes, and how might they relate to specific levers that can be modified in terms of health care access and financial stability,” said Boyle.
The research team notes that their analytical framework—named the geographically-sensitive neighborhood exposome-wide association study—can be applied to any health outcome where the neighborhood is expected to play a role.
Future research is planned to validate and replicate these findings through larger cohorts and more geographically diverse patient populations.
“In the future, we want to integrate more sources of data to demonstrate pathways and make the linkages more distinct, apparent and interpretable,” said Boyle, who previously completed a postdoctoral fellowship as part of the NCI-funded T32 Cancer Prevention and Control training program at Massey, as well as a doctoral program in the Department of Biostatistics. “Connecting publicly available, highly informative data encompassing a wide variety of domains with specific biological changes that relate to cancer outcomes is a driving theme of my team’s work.”
Except for skin cancer, breast cancer is the most common cancer in women in the U.S., and it is the second leading cause of cancer death in women, according to the American Cancer Society . Additionally, significant racial disparities persist when it comes to breast cancer risk and survival, where Black women are more likely to die from breast cancer than any other race or ethnic group.
“The increasing population of breast cancer survivors in the U.S. and disparities in mortality underscore a call for greater attention to risk factors associated with survival outcomes,” Boyle said.
Carrie Miller, Ph.D., MPH , member of the Cancer Prevention and Control research program at Massey, was a collaborator on this study.
JAMA Network Open
10.1001/jamanetworkopen.2025.58256
People
A Geographically Sensitive Neighborhood Exposome–Wide Association Study for Breast Cancer Survival
18-Feb-2026
None reported.