Abstract
Obesity is an established risk factor for many cancers, including breast cancer. However, the complex nature of the underlying mechanisms, coupled with the interaction between individual characteristics and neighborhood obesogenic attributes, contributes to an energy imbalance and a sedentary lifestyle, promoting obesity. This has posed a challenge to our understanding of neighborhood obesogenic attributes associated with this increased risk of breast cancer. We aim to examine how neighborhood attributes affect breast cancer risk and prognosis in the Southern Community Cohort Study (SCCS). We examined a group of more than 41,000 women living in the southeastern United States. Our investigation focused on understanding the association between multiple neighborhood obesogenic indices, including neighborhood socioeconomic status (nSES), restaurant environment index (REI), retail-food environment index (RFEI), park and recreational facilities, and living in a business district. The association between obesogenic indices with breast cancer risk and mortality was analyzed using a multivariable Cox proportional hazards model controlling for individual-level SES and breast cancer risk factors. Additionally, we conducted a stratified analysis of obesogenic indices and breast cancer risk among Black or White participants. Breast cancer was diagnosed in 1,289 participants (3.1%), including 393 White (3.0%) and 896 Black participants (3.2%). Overall, no significant associations were found between neighborhood obesogenic factors and breast cancer risk. However, when analyzed by race and menopausal status, the REI showed an increased risk among White participants (aHR = 1.65, 95% CI 1.06–2.56, p = 0.004, tertile 3 vs. None), particularly postmenopausal women (aHR = 2.39, 95% CI 1.12–5.14, p = 0.024, tertile 3 vs. None). The REI was significantly associated with breast cancer mortality (aHR = 0.38, 95% CI 0.16–0.93, p = 0.035, tertile 1 vs. None). As a conclusion, the REI showed an increased risk among White participants largely attributed to postmenopausal women. The restaurant environment index was associated with reduced breast cancer mortality.
Data availability
The data underlying this manuscript were received from the Southern Community Cohort Study through a data access agreement (https://ors.southerncommunitystudy.org) and linked with neighborhood obesogenic attributes. These data can be available following the data access guidelines established by the Southern Community Cohort Study.
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Acknowledgements
The authors would like to thank the Southern Community Cohort Study team for providing the data and reviewing the manuscript. In addition, we would also like to thank the University of Tennessee Health Science Center (UTHSC)—Oak Ridge National Laboratory (ORNL) Center for Biomedical Informatics for providing the resources needed for conducting this research.
Funding
Research reported in this publication was supported by the National Cancer Institute of the National Institutes of Health under Award Number U01CA202979. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. SCCS data collection was performed by the Survey and Biospecimen Shared Resource which is supported in part by the Vanderbilt-Ingram Cancer Center (P30 CA68485).
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F.A. Kumsa conceived the study, developed the study protocol, conducted data analysis, and drafted the manuscript. J.H. Fowke also played a pivotal role in conceiving the study and analytic strategy and provided critical review and editing. S. Hashtarkhani curated neighborhood-level data and critically reviewed the manuscript. B. White participated in the overall coordination of the project and critically reviewed and edited the manuscript. M. J. Shrubsole facilitated access to SCCS data and critically reviewed the manuscript. A. Shaban-Nejad also conceived the study, oversaw the administrative process, provided critical review and editing, supervised the analysis, and secured funding. All authors have thoroughly reviewed this paper and granted their final approval for its submission.
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Kumsa, F.A., Fowke, J.H., Hashtarkhani, S. et al. Neighborhood obesogenic factors and breast cancer risk and mortality in the Southern community cohort study. Sci Rep (2026). https://doi.org/10.1038/s41598-026-39076-4
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DOI: https://doi.org/10.1038/s41598-026-39076-4
