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July 13, 2026Open Access

Environmental factors shaping cancer outcomes in Alabama: A scoping review

Key Points

This review aims to understand how environmental, social, and structural factors influence cancer outcomes in Alabama.
Identified and reviewed peer-reviewed studies from 1995 to 2024 using PRISMA-ScR guidelines.
Analyzed 21 studies across six key areas relating to environmental factors and cancer outcomes.
Utilized the Robison and Hudson survivorship framework to examine influences on cancer vulnerability.
Cancer disparities in Alabama are linked to geographic, racial, and economic factors.
Communities in the Black Belt face higher exposure to environmental hazards and increased cancer rates.
Exposures to hazardous environments are connected to higher rates of colorectal, ovarian, and blood cancers.

Abstract

Abstract Purpose This scoping review explores how environmental, social, and structural factors influence cancer outcomes in Alabama. Using the Robison and Hudson (2014) survivorship framework, we examined how individual, healthcare provider, and system-level factors influence cancer vulnerability across communities in Alabama. Methods Following PRISMA-ScR reporting and Joanna Briggs Institute guidelines, we identified and reviewed peer-reviewed studies published between 1995 and 2024 across five databases (PubMed, Embase, Scopus, CINAHL, and PsychINFO). Twenty-one studies met the inclusion criteria and were analyzed across six key areas: food and neighborhood environment, exposure assessment and environmental measurement methods, industrial/toxic releases as exposures, legacy/historical exposures and hematologic outcomes, socioeconomic environment and cancer incidence and racial disparities, community burden, and environmental risk. Results Cancer disparities in Alabama are closely tied to geographic, racial, and economic factors. Communities in the Black Belt and industrial corridors face higher exposure to environmental hazards due to historical segregation and industrial development patterns. These exposures are linked to increased rates of colorectal, ovarian, and blood cancers, particularly in areas with persistent poverty and limited access to healthcare. Conclusions Cancer outcomes in Alabama cannot be separated from the broader social and environmental context. Understanding these connections is essential for addressing the drivers’ underlying health disparities. Implications for Cancer Survivors Improving cancer survivorship in Alabama requires a comprehensive approach that includes environmental risk assessments, enhanced provider education, and community-driven prevention. These approaches may include local screening initiatives, environmental cleanup, and targeted outreach to high-risk populations.

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