Does historic redlining—a form of structural racism—affect survival in young people with cancer?

A recent study indicates that children and young adults with cancer face an elevated risk of dying if they live in previously redlined neighborhoods—residential areas marked in the 1920s–1930s by lenders as undesirable for mortgage loans due to their racial demographics. The findings are published by Wiley online in CANCER, a peer-reviewed journal of the American Cancer Society.

Historic redlining prevented Black households and other communities of color from accessing home mortgages for many years, leading to economic disadvantage and racial segregation. Although historic redlining has been linked to poor health outcomes, including mortality in people with adult-onset cancers, its relationship with survival in pediatric, adolescent, and young adult individuals with cancer is unknown.

To investigate, Kristine Karvonen, MD, MS, of the Fred Hutchinson Cancer Center in Seattle, and her colleagues analyzed a U.S. cancer registry to identify all new cancer diagnoses in people under age 40 living in Seattle and Tacoma, Washington, between 2000 and 2019.

Among 4,355 young individuals diagnosed with cancer, the percentage of people alive at 5 years was lower among those residing in redlined neighborhoods compared with those in other neighborhoods (85.1% versus 90.3%). Survival differences persisted at 10 years (81.1% versus 88.1%). After adjusting for other influencing factors, people in redlined neighborhoods had a 32% higher risk of dying than those in other neighborhoods.

“This study agrees with previous research that living in an area that was previously redlined nearly a century ago is associated with poor outcomes for patients with cancer today and adds young patients with cancer as a population at risk. Therefore, our study names racism as a potential driver of outcomes for young patients with cancer,” said Dr. Karvonen. “In light of our findings of increased mortality experienced by redlined individuals, an important next question is how these disparities arise, as mechanisms will be key to informing future interventions. Additionally, further studies are needed to build upon this historical example and examine more proximal measures of structural racism relevant to patients today.”

Additional information
NOTE: The information contained in this release is protected by copyright. Please include journal attribution in all coverage. A free abstract of this article will be available via the CANCER Newsroom upon online publication. For more information or to obtain a PDF of any study, please contact: Sara Henning-Stout, newsroom@wiley.com

Full Citation:
“Historical redlining and survival among children, adolescents, and young adults with cancer diagnosed between 2000-2019 in Seattle and Tacoma, Washington.” Kristine A. Karvonen, David R. Doody, Dwight Barry, Kira Bona, Lena E. Winestone, Abby R. Rosenberg, Jason A. Mendoza, Stephen M. Schwartz, and Eric J. Chow. CANCER; Published Online: January 27, 2025 (DOI: 10.1002/cncr.35677).
URL Upon Publication: http://doi.wiley.com/10.1002/cncr.35677

Author Contact: media@fredhutch.org

About the Journal     
CANCER is a peer-reviewed publication of the American Cancer Society integrating scientific information from worldwide sources for all oncologic specialties. The objective of CANCER is to provide an interdisciplinary forum for the exchange of information among oncologic disciplines concerned with the etiology, course, and treatment of human cancer. CANCER is published on behalf of the American Cancer Society by Wiley and can be accessed online. Follow CANCER on X @JournalCancer and Instagram @ACSJournalCancer, and stay up to date with the American Cancer Society Journals on LinkedIn.

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