Across urban landscapes in the United States, the lingering shadows of discriminatory housing policies from nearly a century ago continue to shape the health outcomes of millions, particularly women diagnosed with breast cancer. New research from the University at Buffalo reveals how the federal practice known as redlining—officially outlawed in 1968—maintains a pernicious grip on breast cancer survival rates, pointing to a complex interplay of socio-environmental factors rooted in historical segregation.
Redlining was institutionalized in 1934 by the Federal Housing Administration (FHA), which assessed neighborhoods based on race, ethnicity, economic status, and land usage to determine mortgage lending eligibility. Neighborhoods were graded from A to D—deemed best to hazardous respectively—with predominantly Black urban communities disproportionately assigned the lowest ‘D’ grade, marked in red on maps, which effectively cut them off from critical homeownership and investment opportunities. Though outlawed over five decades ago, the consequences of these artificially imposed boundaries reverberate through persistent social inequities and environmental disparities that influence health decades later.
At the heart of this groundbreaking study, led by Sarah M. Lima, a doctoral candidate in epidemiology at UB, lies a vast dataset analyzing nearly 61,000 breast cancer cases diagnosed in New York State from 2008 to 2018. The research bridges historical housing segregation with contemporary cancer epidemiology, revealing a graded correlation between the redlining status of neighborhoods and all-cause mortality following breast cancer diagnosis. Women residing in historically redlined neighborhoods demonstrated significantly worse five-year survival rates compared to their counterparts in A-graded areas, even when controlling for insurance, treatment type, and present-day socioeconomic status of their neighborhoods.
Specifically, breast cancer patients in B, C, and D-graded neighborhoods faced 1.29, 1.37, and 1.64 times higher risks of death respectively than those in A neighborhoods. These results underscore that the neighborhood environment itself—shaped by its redlining legacy—affects health outcomes independently of individual patient resources. Moreover, these communities exhibited a higher prevalence of aggressive cancer phenotypes, including hormone receptor-negative tumors and triple-negative breast cancer, as well as diagnoses at more advanced metastatic stages, underscoring the multifaceted influence of neighborhood factors on cancer progression.
The persistence of redlining’s impact is multifactorial. Historically redlined areas often became sites for highways and industrial infrastructure, exposing residents to elevated levels of pollution and toxic contaminants, while simultaneously lacking adequate green spaces such as parks and tree cover. This environmental degradation compounds socioeconomic disadvantages—lower homeownership rates, reduced wealth accumulation, limited access to healthy foods, and insufficient healthcare resources—all of which constitute an adverse neighborhood context that can influence breast cancer biology and survival.
Complementing the survival analysis, a second large-scale investigation encompassing nearly 13,000 U.S. neighborhoods delved into the clustering patterns of established breast cancer risk and prognostic factors across regions. Approximately three-quarters of these neighborhoods bore the hallmarks of historical redlining. This study found that, with some exceptions like binge drinking, redlined neighborhoods exhibited a higher burden of risk factors—including lower high school educational attainment, greater physical inactivity, and higher rates of uninsured individuals—factors well-documented to negatively impact breast cancer outcomes.
The research also unveiled striking geographic heterogeneity in risk factor profiles. For example, in the Southern United States, obesity, smoking, and physical inactivity in redlined areas emerged as dominant contributors to breast cancer risk, suggesting region-specific intervention targets. Conversely, in the Western regions, deficiencies in routine medical care access and mammography screening were more pronounced, indicating a need to enhance preventive healthcare infrastructure. Such granular understanding supports tailored public health initiatives designed to dismantle the entrenched cancer disparities rooted in redlining.
The collaboration between University at Buffalo researchers and the New York State Department of Health underscores the power of integrating cancer registry data with environmental and sociodemographic indices to elucidate place-based health inequities. Dr. Tabassum Insaf, who directs the Bureau of Cancer Epidemiology, emphasized that neighborhood histories profoundly affect cancer survival, advancing a paradigm wherein cancer epidemiology incorporates environmental justice as a central axis of inquiry.
Intriguingly, this research highlights that discriminatory policies, though rescinded legally many decades ago, established structural pathways that continue to perpetuate health inequities. Redlining created what Lima describes as a “perfect storm” by intertwining adverse environmental exposures with socioeconomic deprivation, cultivating neighborhood ecosystems that potentiate aggressive breast cancer biology and diminish survival chances. It challenges researchers and policymakers to consider historic urban planning decisions as fundamental determinants of modern health outcomes.
The studies call for increased vigilance among women living in historically marginalized neighborhoods to prioritize timely breast cancer screening, as early detection remains a critical modifiable factor in survival. Moreover, they emphasize the urgent need to address the lingering effects of systemic segregation through investments in environmental remediation, improved access to healthcare, and enhanced social resources. This holistic approach acknowledges that breast cancer disparities are not merely medical concerns but are deeply embedded in the urban fabric shaped by generations of policy.
By illustrating the intersection between historical housing discrimination and contemporary cancer epidemiology, this research contributes to a broader understanding of how socio-environmental exposures influence disease trajectories. It also sets a foundation for public health strategies aiming to unravel and mitigate the pervasive legacy of racism and segregation in health outcomes, marking a significant step forward in the fight for cancer equity.
While the origins of breast cancer are complex and multifactorial, these findings reveal that the physical and social environments forged by past injustices remain active variables in disease progression. Future research integrating molecular cancer biology with geospatial and social data may further unravel the mechanisms through which these entrenched disparities manifest, enabling the design of precision interventions that not only treat but also prevent breast cancer in vulnerable populations.
Ultimately, these studies serve as a powerful reminder that the scars of historical housing policies are etched not only in the urban landscape but also in the very biology of communities. Addressing breast cancer mortality disparities requires confronting this legacy head-on, leveraging epidemiologic insights to inform equitable healthcare policy, urban planning, and community engagement.
Subject of Research: People
Article Title: Historical Redlining and All-Cause Survival after Breast Cancer Diagnosis
News Publication Date: 23-Apr-2025
Web References:
- https://aacrjournals.org/cebp/article-abstract/doi/10.1158/1055-9965.EPI-24-1862/754632/Historical-redlining-and-all-cause-survival-after?redirectedFrom=PDF
- https://link.springer.com/article/10.1007/s10552-024-01950-9
References: University at Buffalo research papers in Cancer Epidemiology, Biomarkers & Prevention and Cancer Causes & Control
Keywords: Health and medicine; Breast cancer; Epidemiology
