SAN ANTONIO — Living in food deserts and food swamps — areas with no access to healthy food, and areas with a plethora of unhealthy food options — may raise the risk of dying from postmenopausal breast cancer, a novel ecological study has found.
"Food deserts and food swamps are both bad, but it's worse in food swamps," Malcolm Bevel, PhD, MSPH, with Augusta University in Georgia, told Medscape Medical News.
He presented his research here at the San Antonio Breast Cancer Symposium (SABCS) 2023.
Breast cancer is the fourth leading cause of cancer death in the United States and is one of 13 obesity-related cancers. Healthy food consumption is a protective factor shown to decrease obesity risk and postmenopausal breast cancer mortality.
However, residing in food deserts or food swamps reduces access to healthy foods and has been severely understudied regarding postmenopausal breast cancer mortality, Bevel explained.
To investigate, Bevel and colleagues did a cross-sectional, ecological analysis where they merged 2010 to 2020 postmenopausal breast cancer mortality data from the Centers for Disease Control and Prevention (CDC) with aggregated 2012 to 2020 data from the US Department of Agriculture Food Environment Atlas.
A food swamp score was calculated as the ratio of fast-food and convenience stores to grocery stores and farmer's markets.
A food desert score was calculated as the proportion of residents living more than 1 mile (urban) or 10 miles (rural) from a grocery store and household income ≤ 200% of the federal poverty threshold.
The researchers categorized food deserts and food swamps as low, moderate, or high, with higher scores denoting counties with fewer resources for healthy food.
Counties with high postmenopausal breast cancer mortality rates had a higher percentage of non-Hispanic Black population (5.8% vs. 2.1%), poverty rates (17.2% vs 14.2%), and adult obesity (32.5% vs 32%) and diabetes rates (11.8% vs 10.5%), compared with counties with low postmenopausal breast cancer mortality rates, Bevel reported.
The age-adjusted odds of counties having high postmenopausal breast cancer mortality was 53% higher in counties with high food desert scores (adjusted odds ratio [aOR] 1.53; 95% CI, 1.26 - 1.88), and over twofold higher in those with high food swamp scores (aOR, 2.09; 95% CI: 1.69 - 2.58).
In fully adjusted models, the likelihood of counties having moderate postmenopausal breast cancer mortality rates was 32% higher in those with moderate food swamp scores (aOR, 1.32; 95% CI, 1.03 - 1.70).
Growing Epidemic Requires System Change
These findings are in line with another study by Bevel and his colleagues published earlier this year in JAMA Oncology.
In that study, communities with easy access to fast food were 77% more likely to have high levels of obesity-related cancer mortality, as reported by Medscape Medical News.
There is a "growing epidemic" of food deserts and food swamps in the US, which could be due to systemic issues such as gentrification/redlining and lack of investment with chain grocery stores that provide healthy food options, said Bevel.
Local policymakers and community stakeholders could implement culturally tailored, sustainable interventions for obesity and obesity-related cancer prevention, including postmenopausal breast cancer. These could include creating more walkable neighborhoods and community vegetable gardens, he suggested.
"This is an important study demonstrating how the environment impacts outcomes in postmenopausal women diagnosed with breast cancer," said Lia Scott, PhD, MPH, discussant for the study.
"Most of the literature is primarily focused on food deserts to characterize the food environment. However, these authors looked at both food deserts and food swamps. And even after adjusting for various factors and age, counties with high food swamp scores at greater odds of having higher postmenopausal breast cancer mortality rates," said Scott, who is from Georgia State University School of Public Health in Atlanta.
"There is a clear need for systems change. With ecological studies like this one, we could potentially drive policy by providing actionable data," she added.
The study had no specific funding. Bevel and Scott report no relevant financial relationships.
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