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This research investigates the impact of neighborhood deprivation on Oncotype DX recurrence scores among Black and White women with ER-positive breast cancer.

June 1, 2026Open Access

Neighborhood deprivation and oncotype DX recurrence scores among Black and White women: the interplay between race, place, and tumor biology

Key Points

This research investigates the impact of neighborhood deprivation on Oncotype DX recurrence scores among Black and White women with ER-positive breast cancer.
Analyzed data from 11,377 non-Hispanic Black and White women diagnosed with ER-positive breast cancer from 2010-2017.
Used the Neighborhood Deprivation Index derived from American Community Survey data to assess neighborhood deprivation in quartiles.
Estimated prevalence ratios (PR) for high-risk Oncotype DX scores, comparing those in most deprived versus least deprived neighborhoods.
Overall association of neighborhood deprivation with high-risk ODX RS (PR = 1.08, 95% CI 0.90–1.30).
High-risk ODX RS among NHW women in deprived neighborhoods (PR = 1.12, 95% CI 0.87–1.44).
NHB women in the least deprived areas had higher high-risk ODX RS compared to NHW women (PR = 1.92, 95% CI 1.53–2.41).

Abstract

Abstract Breast cancer mortality disparities have persisted between non-Hispanic Black (NHB) and non-Hispanic White (NHW) women, even among those with prognostically favorable disease. The Oncotype DX Recurrence Score (ODX RS) is a gene expression panel used to identify estrogen receptor (ER)-positive breast cancers with aggressive tumor biology, and prior studies suggest higher scores among Black women and in lower-socioeconomic areas. We examined associations of neighborhood deprivation with ODX RS among 11,377 NHB and NHW women diagnosed with ER-positive breast cancer (stage I-IIIa, ≤3 lymph nodes) between 2010-2017 in the Georgia Cancer Registry. The Neighborhood Deprivation Index (NDI), derived via principal component analysis of American Community Survey block-group data, was assessed in quartiles. Prevalence ratios (PR) and 95% confidence intervals (CI) were estimated for high-risk (≥31) versus low-risk (<18) ODX RS. Living in the most deprived neighborhoods was modestly associated with high-risk ODX RS overall (PR = 1.08, 95% CI 0.90–1.30) and among NHW women (PR = 1.12, 95% CI 0.87–1.44), but not among NHB women (PR = 1.01, 95% CI 0.77–1.33). NHB women in the least deprived neighborhoods had the highest prevalence of high-risk ODX RS relative to NHW women in those neighborhoods (PR = 1.92, 95% CI 1.53–2.41). These findings suggest neighborhood deprivation does not explain racial differences in genomic risk.

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