{"doi":"10.1007/s10552-025-02054-8","title":"County-level socioeconomic status, rurality, and second primary cancer risk among breast cancer survivors in the United States","abstract":"<jats:title>Abstract</jats:title>\n                  <jats:sec>\n                    <jats:title>Background</jats:title>\n                    <jats:p>Breast cancer survivors have an increased risk of second primary cancers (SPCs), the role of county-level socioeconomic status and rurality—factors that may influence access to treatment, surveillance, and preventive care—remains understudied.</jats:p>\n                  </jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods</jats:title>\n                    <jats:p>We identified 721,957 women with localized/regional first primary breast cancer who survived ≥ 1 year in 17 Surveillance, Epidemiology, and End Results registries (2000–2018). We used Cox regression to assess associations between county-level median household income (proxy for socioeconomic status), rurality, and their joint effects on invasive SPC risk, adjusting for demographic and clinical factors. We examined risk for all SPCs, non-breast SPCs, and the three most common SPC sites (breast, lung/bronchus, colorectal). Models were further stratified by index breast cancer characteristics.</jats:p>\n                  </jats:sec>\n                  <jats:sec>\n                    <jats:title>Results</jats:title>\n                    <jats:p>\n                      During 6.1 median years of follow-up, 65,954 survivors developed an SPC (42,400 non-breast; 23,554 breast, 8,338 lung/bronchus, 5,442 colorectal). Survivors from lower-income counties had higher SPC risk (&lt; $50,000 vs. ≥ $75,000: HR = 1.07, 95% CI = 1.04–1.10), driven by lung/bronchus (HR = 1.32, 95% CI = 1.23–1.42) and colorectal cancers (HR = 1.19, 95% CI = 1.09–1.31). Lung/bronchus cancer risk was stronger among younger (age &lt; 50: HR = 1.95, 95% CI = 1.59–2.39, age ≥ 50: HR = 1.20, 95% CI = 1.12–1.28;\n                      <jats:italic>p</jats:italic>\n                      interaction &lt; 0.001) and Estrogen Receptor (ER)-negative survivors (ER negative: HR = 1.50, 95% CI = 1.31–1.72; ER positive: HR = 1.21, 95% CI = 1.12–1.30;\n                      <jats:italic>p</jats:italic>\n                      interaction = 0.02). Survivors from rural counties had higher SPC risk compared with most urban counties (HR range:1.07–1.12), especially for lung/bronchus cancer in younger (age &lt; 50: HR = 1.66, 95% CI = 1.34–2.05, age ≥ 50: HR = 1.13, 95% CI = 1.06–1.21;\n                      <jats:italic>p</jats:italic>\n                      interaction = 0.001) and ER-negative survivors (ER negative: HR = 1.45, 95% CI = 1.26–1.67; ER positive: HR = 1.11, 95% CI = 1.03–1.20;\n                      <jats:italic>p</jats:italic>\n                      interaction = 0.001). Survivors in rural/lower-income counties had the highest SPC risk compared with urban/higher-income counties (HR-range: 1.20–1.23), particularly for lung/bronchus cancer (HR = 1.57, 95% CI = 1.10–2.23).\n                    </jats:p>\n                  </jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion</jats:title>\n                    <jats:p>Studies are needed to understand factors driving the impact of socioeconomic status and rurality (e.g., access to care) on SPC risk to inform preventive strategies for breast cancer survivors.</jats:p>\n                  </jats:sec>","journal":"Cancer Causes &amp; Control","year":2025,"id":596817,"datarank":0.10397207708399181,"base_score":0.6931471805599453,"endowment":0.6931471805599453,"self_citation_contribution":0.10397207708399181,"citation_network_contribution":0.0,"self_endowment_contribution":0.10397207708399181,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":1,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":null,"is_data_producer":false,"deposit_databanks":null,"is_oa":false,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":null,"fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":1187431,"name":"Carolyn Brandt","orcid":null,"position":1,"is_corresponding":false},{"id":513584,"name":"Jessica Li","orcid":"0000-0001-8948-2904","position":2,"is_corresponding":false},{"id":1528639,"name":"Geetanjali Datta","orcid":null,"position":3,"is_corresponding":false},{"id":520816,"name":"Justin X. Moore","orcid":"0000-0002-5496-752X","position":4,"is_corresponding":false},{"id":886670,"name":"Lene H. S. Veiga","orcid":"0000-0002-6537-1481","position":5,"is_corresponding":false},{"id":302470,"name":"Gretchen L. Gierach","orcid":"0000-0002-0165-5522","position":6,"is_corresponding":false},{"id":251248,"name":"Amy Berrington de González","orcid":"0000-0002-7332-8387","position":7,"is_corresponding":false},{"id":672906,"name":"Jacqueline B. Vo","orcid":"0000-0001-8891-4437","position":8,"is_corresponding":false},{"id":663913,"name":"Cody Ramin","orcid":"0000-0002-2007-2840","position":9,"is_corresponding":false},{"id":1388865,"name":"Katherine Ho","orcid":"0000-0002-0746-2422","position":0,"is_corresponding":false}],"reference_count":0,"raw_metadata":{"has_enrichment":true,"resolved":true,"title":"County-level socioeconomic status, rurality, and second primary cancer risk among breast cancer survivors in the United States","abstract":"<jats:title>Abstract</jats:title>\n                  <jats:sec>\n                    <jats:title>Background</jats:title>\n                    <jats:p>Breast cancer survivors have an increased risk of second primary cancers (SPCs), the role of county-level socioeconomic status and rurality—factors that may influence access to treatment, surveillance, and preventive care—remains understudied.</jats:p>\n                  </jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods</jats:title>\n                    <jats:p>We identified 721,957 women with localized/regional first primary breast cancer who survived ≥ 1 year in 17 Surveillance, Epidemiology, and End Results registries (2000–2018). We used Cox regression to assess associations between county-level median household income (proxy for socioeconomic status), rurality, and their joint effects on invasive SPC risk, adjusting for demographic and clinical factors. We examined risk for all SPCs, non-breast SPCs, and the three most common SPC sites (breast, lung/bronchus, colorectal). Models were further stratified by index breast cancer characteristics.</jats:p>\n                  </jats:sec>\n                  <jats:sec>\n                    <jats:title>Results</jats:title>\n                    <jats:p>\n                      During 6.1 median years of follow-up, 65,954 survivors developed an SPC (42,400 non-breast; 23,554 breast, 8,338 lung/bronchus, 5,442 colorectal). Survivors from lower-income counties had higher SPC risk (&lt; $50,000 vs. ≥ $75,000: HR = 1.07, 95% CI = 1.04–1.10), driven by lung/bronchus (HR = 1.32, 95% CI = 1.23–1.42) and colorectal cancers (HR = 1.19, 95% CI = 1.09–1.31). Lung/bronchus cancer risk was stronger among younger (age &lt; 50: HR = 1.95, 95% CI = 1.59–2.39, age ≥ 50: HR = 1.20, 95% CI = 1.12–1.28;\n                      <jats:italic>p</jats:italic>\n                      interaction &lt; 0.001) and Estrogen Receptor (ER)-negative survivors (ER negative: HR = 1.50, 95% CI = 1.31–1.72; ER positive: HR = 1.21, 95% CI = 1.12–1.30;\n                      <jats:italic>p</jats:italic>\n                      interaction = 0.02). Survivors from rural counties had higher SPC risk compared with most urban counties (HR range:1.07–1.12), especially for lung/bronchus cancer in younger (age &lt; 50: HR = 1.66, 95% CI = 1.34–2.05, age ≥ 50: HR = 1.13, 95% CI = 1.06–1.21;\n                      <jats:italic>p</jats:italic>\n                      interaction = 0.001) and ER-negative survivors (ER negative: HR = 1.45, 95% CI = 1.26–1.67; ER positive: HR = 1.11, 95% CI = 1.03–1.20;\n                      <jats:italic>p</jats:italic>\n                      interaction = 0.001). Survivors in rural/lower-income counties had the highest SPC risk compared with urban/higher-income counties (HR-range: 1.20–1.23), particularly for lung/bronchus cancer (HR = 1.57, 95% CI = 1.10–2.23).\n                    </jats:p>\n                  </jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion</jats:title>\n                    <jats:p>Studies are needed to understand factors driving the impact of socioeconomic status and rurality (e.g., access to care) on SPC risk to inform preventive strategies for breast cancer survivors.</jats:p>\n                  </jats:sec>","is_dataset_classified":null,"base_score":0.6931471805599453,"endowment":0.6931471805599453,"datacite_reuse_total":0,"file_count":0,"downloads":0,"views":0,"has_version_chain":false,"is_dataset":false,"is_oa":false,"pmid":"40906319","pmcid":"PMC12630244","openalex_id":"https://openalex.org/W4413977595","authors":[],"funders":[{"funder_name":"National Cancer Institute","grant_id":"T32 CA009314","title":null},{"funder_name":"Cedars-Sinai Cancer","grant_id":"","title":null},{"funder_name":"Intramural Research Program","grant_id":"","title":null},{"funder_name":"Cedars-Sinai Medical Center","grant_id":"","title":null}],"total_grants":4,"fwci":0.768,"citation_percentile":0.74714295,"influential_citations":0,"citation_trend":[{"year":2026,"count":1}],"oa_status":"hybrid","license":"cc-by","oa_locations":[{"url":"https://link.springer.com/content/pdf/10.1007/s10552-025-02054-8.pdf","host_type":"journal"},{"url":"https://link.springer.com/content/pdf/10.1007/s10552-025-02054-8.pdf","host_type":"publisher"},{"url":"https://link.springer.com/article/10.1007/s10552-025-02054-8/fulltext.html","host_type":"publisher"},{"url":"https://doi.org/10.1007/s10552-025-02054-8","host_type":"journal"},{"url":"https://pubmed.ncbi.nlm.nih.gov/40906319","host_type":"repository"},{"url":"https://www.ncbi.nlm.nih.gov/pmc/articles/12630244","host_type":"repository"},{"url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC12630244/pdf/10552_2025_Article_2054.pdf","host_type":"repository"},{"url":"https://europepmc.org/articles/PMC12630244","host_type":"Europe_PMC"},{"url":"https://europepmc.org/articles/PMC12630244?pdf=render","host_type":"Europe_PMC"}],"fields_of_study":["Multiple and Secondary Primary Cancers","Breast Cancer Treatment Studies","Cancer Risks and Factors","Humans","Female","Breast Neoplasms","Cancer Survivors","Neoplasms, Second Primary","United States","Middle Aged","Rural Population","Aged","Social Class","Risk Factors","SEER Program","Adult","Follow-Up Studies"],"mesh_terms":["Cancer Survivors","Adult","Aged","Breast Neoplasms","Female","Follow-Up Studies","Humans","Middle Aged","Risk Factors","Rural Population","Social Class","United States","Neoplasms, Second Primary","SEER Program"],"keywords":["Medicine","Breast cancer","Socioeconomic status","Internal medicine","Epidemiology","Proportional hazards model","Colorectal cancer","Oncology","Gynecology","Demography","Cancer","Population","Environmental health","survivorship","Second Primary Cancer","Rurality"],"sdg_mappings":[],"linked_datasets":[],"clinical_trials":[],"software_tools":[],"database_accessions":[],"source":"live","citation_network_status":"fetched"},"created_at":"2026-07-28T11:24:25.260501Z","pmid":null,"pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}