Zip codes didn’t exist until 1963 and were established to help speed the delivery of mail. Today, we rely much less on paper mail but strangely, zip codes play a bigger role.They define our neighborhoods, which define our schools, food stores, health centers, even our risk of cancer.
There are many factors that influence the risk of cancer. Many of those factors vary depending on where a person lives. Dana-Farber is working to reach more people in zip codes in the Boston area and beyond with programs that aim to reduce cancer risk, increase cancer screening rates, and direct people to Dana-Farber for cancer treatment and survivorship services when they are needed.
“We are partnering with communities and health centers across Boston so that every person in every neighborhood can benefit from the incredible strides that have been made in cancer prevention and treatment,” says Christopher Lathan, MD, MPH, founding director of the Cancer Care Equity Program at Dana-Farber.
How significant are health disparities and cancer disparities from one neighborhood to the next?
Christopher Lathan, MD, MPH, founding director of the Cancer Care Equity Program at Dana-Farber
The health differences can be stark. A 2023 report from the Boston Public Health Commission found that residents of affluent, predominantly white neighborhoods had a life expectancy of 92 years – 23 years longer than those living in a low-income predominantly non-white neighborhood.
Cancer, specifically, is a leading cause of death in Boston. A community assessment of needs led by Dana-Farber found that the number of deaths from cancer in the Boston area declined for white, Black, Asian, and Latino residents between 2010 and 2021. But this was not the case for all zip codes. Several neighborhoods did not have declining cancer rates during this time.
How does where you live influence cancer risk?
There are several environmental, economic, and social factors tied to cancer risk. Here are a few examples:
Air pollution and water pollution
- Some neighborhoods have fewer resources for building maintenance. As a result, people living there might be more likely to be exposed to toxins from asbestos in building materials, smoke from indoor fuel sources, or cooking smoke. These environmental exposures can increase the risk of lung cancer.
- A neighborhood near an industrial zone might also have higher levels of air pollution or water pollution due to runoff or emissions from industrial facilities such as manufacturing plants, coal plants, or factories. Water pollutants include chlorinated by-products, nitrates, arsenic, radioactive particles, herbicides, pesticides, and fertilizers.
Food deserts
- Some neighborhoods are called “food deserts” because they don’t have nearby grocery stores that sell fresh, whole foods. This lack of basic resources limits residents’ ability to purchase fresh, whole foods and makes it harder to avoid ultraprocessed foods, which can increase the risk of obesity — a factor linked to 13 types of cancer, including colorectal cancer.
- Neighborhoods without safe outdoor spaces or facilities for exercise can also increase the risk of obesity and make it harder for people to live an active lifestyle. Regular exercise is one of the best ways to stay healthy, but getting exercise is much harder for some people simply because of where they live.
Access to health care
- A rural neighborhood might be very far from a medical center, making screening for cancer or seeking cancer care more difficult. Delays in diagnosis or treatment can make cancer harder to treat.
- Lower-resource neighborhoods can occur in both urban and rural settings and those communities may lack nearby medical centers or cancer care expertise. People in lower-resource neighborhoods often have less access to health resources and information about cancer risks, cancer prevention, limiting their ability to seek timely care.
Race and ethnicity
In the U.S., systemic racism has led to health disparities among historically marginalized groups. Black, Hispanic, and non-white people are more likely to live in lower-income neighborhoods with fewer resources. These neighborhoods may also have more people for whom English is a second language. Limited access to healthcare and language barriers, contribute to higher cancer disparities in these communities.
What is Dana-Farber doing to reduce cancer disparities in Boston-area neighborhoods?
Dana-Farber teams are actively working to address disparities through a range of partnerships within neighborhoods in the Boston area. These efforts aim to help more people learn about cancer risks and prevention, screening, diagnosis, treatment, and survivorship.
Dana-Farber’s Community Health is committed to reaching at-risk, historically marginalized, and diverse populations in the Boston area so they can access educational and supportive programs. Dana-Farber’s Cancer Care Equity Program (CCEP) is committed to working with community health centers to develop and implement clinical interventions that reduce cancer disparities, particularly in neighborhoods experiencing cancer disparities.
Magnolia Contreras, MSW, MBA, vice president of Community Health at Dana-Farber.
Examples of programs include:
Prevention: Examples include an HPV-Related Cancer Outreach Program, a Sun Safety and Skin Cancer Prevention Program, and a Tobacco Treatment Program, all of which are available in communities in the Boston area that stand to benefit most.
Screening: A Mammography Van visits many communities and prioritizes reaching women who are low-income, elderly, immigrant or non-English speaking. A tool called AssessYourRisk helps educate people about their risk of breast and ovarian cancer is also available online and is actively shared with priority communities.
Diagnosis: The Cancer Care Equity Program’s Clinical Outreach Initiative has clinical interventions in community hospitals that are helping speed cancer diagnosis for patients. The Centers for Early Detection and Intervention also has several initiatives focused on ensuring early diagnosis, treatment, and related research programs are reaching as many people as possible.
Treatment: The CCEP also has a Patient Navigation Program, in which patient navigators are paired with patients from priority zip codes to help them overcome barriers to care, including helping them with challenges including transportation, food, housing, and more.
Dana-Farber also has two main campuses and several community-based locations so that more patients can receive Dana-Farber cancer care close to home.