
 It is important to establish if exposure to green space provides a protective effect for breast cancer development and progression to advocate for expanded access to green space areas for 1) those at-risk and 2) cancer patients receiving treatment. There is an association of residential proximity to green space with decreased breast cancer incidence. Current studies have not evaluated how patient variables may affect this relationship. We sought to determine if patient-level green space proximity correlated to social determinants of health such as poverty or minority status, or patient physiologic or inflammatory molecular markers in breast cancer patients. A retrospective analysis of baseline demographic data (including addresses) and cytokine profiles from breast cancer patients who had enrolled on investigator initiated trials at our institution was performed. National Land Cover Database and Philadelphia Parks & Recreation data was used to identify green space indicators such as patient proximity and neighborhood density of green space and tree canopy and was correlated to the patient’s systemic inflammation. Pearson coefficients were performed to identify relationships between green space indicators and inflammation. Patients were accrued to investigator initiated trials between 2013-2019. All had a diagnosis of ductal carcinoma in situ or invasive breast cancer. The median age of the women on the study was 63 years old, 42% were black, and 64% were considered of low socioeconomic status. The fraction of total area within a 250-meter radius of each patient’s address that has low vegetation or tree canopy was calculated. More women with above the median percentage of low vegetation within 250 meters of their residence had elevated levels of the anti-inflammatory cytokine TGF-B (p <0.001). In addition, living with above the median percentage of low vegetation within 250 meters of their residence was associated with having higher levels of IGF-BP3 (p <0.001). In our diverse patient population who experience adverse social determinants of health, an inverse correlation was noted between residential proximity to greenspace indicators and inflammation. These results could be used to advocate for expanded access to green space, especially among those with lowest resources, as increased inflammation is associated with breast cancer incidence and progression.
 Citation Format: Taylor Micua, Joseph Lombardo, Alex M DesJarlais, Benjamin C. Keating, Melissa Lazar, Charnita Zeigler-Johnson, Adeseye Adekeye, Edith Mitchell, Russell K. McIntire, Nicole L. Simone. Proximity to green space and inflammation among breast cancer patients [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr C092.

Abstract C092: Proximity to green space and inflammation among breast cancer patients


 Access to green space has been shown to be associated with decreased incidence of cancer. The goal of this study is to identify associations between neighborhood green space indicators and breast cancer outcomes at the neighborhood level in Philadelphia.
 Green space indicators were sourced from the National Land Cover Database (2006-2016), VT Spatial Analysis Lab (2008-2013) and Philadelphia Parks and Recreation (2016), and included average percent tree cover, average tree canopy, average low vegetation, count of public parks, and percent vacant lots. Breast cancer data from the PA Cancer Registry (2005-2014) included standardized incidence ratio (SIR), standardized mortality ratio (SMR), and mean aggressiveness (MA) of cancer. Neighborhood-level covariates were gathered from U.S. Census (American Communities Survey, 2008-2012) and the Public Health Management Corporation’s Household Health Survey (2012) for Philadelphia neighborhoods.
 Pearson correlations were calculated to identify associations between environmental and green space indicators and breast cancer outcomes. Multivariable linear regression was used to identify if significant relationships persisted in the presence of demographic and socioeconomic disparities at the neighborhood level. Significance was determined at p-values < 0.05.
 SIR was significantly correlated with % of vacant lots (r=-.186), % of tree canopy cover within 50 meters from neighborhood centroid (r=.139) and the number of public parks (r=.125) per neighborhood. SMR was significantly correlated with vacant lots (r=.184) and tree canopy cover (r=-.104). MA was significantly correlated with tree canopy (r=-.124), tree canopy within fifty meters of neighborhood centroid (r=-.146), number of public parks (r=-.141), and % of vacant lots (r=.157). After controlling for covariates in multivariable linear regression models, the significant relationships between neighborhood green space indicators and breast cancer outcomes were no longer significant.
 For SIR, the significant associations with green space indicators suggest that Philadelphia neighborhoods with a higher incidence of breast cancer have more green space and a lower % of vacant lots. For SMR and MA, associations suggest that neighborhoods with higher breast cancer mortality and aggressiveness have less green space and a higher % of vacant lots. The direction of these relationships makes sense, given the % and quality of neighborhood green space correlate closely with indicators of socioeconomic status. The lack of significance when controlling for confounders likely represents the limitations of using neighborhood-level data, rather than patient-level data, to measure the impact of green space on breast cancer outcomes. Future studies should identify green space exposure indicators at the individual level in order to more accurately identify the impact of urban green space on breast cancer outcomes. These data could inform city planning to decrease the burden of breast cancer among vulnerable populations.
 Citation Format: Benjamin C. Keating, Joseph Lombardo, Charnita Zeigler-Johnson, Alex M. DesJarlais, Taylor Micua, Nicole L. Simone, Russell K. McIntire. Associations between neighborhood green space and breast cancer outcomes among Philadelphia neighborhoods [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr C090.

Abstract C090: Associations between neighborhood green space and breast cancer outcomes among Philadelphia neighborhoods

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Abstract C092: Proximity to green space and inflammation among breast cancer patients

Abstract C090: Associations between neighborhood green space and breast cancer outcomes among Philadelphia neighborhoods