Skip to main content
An official website of the United States government

Geographic Disparities in Cardiovascular Disease Mortality Risk Among Breast Cancer Survivors

, by Elise Tookmanian, Ph.D.

A healthcare provider checks the heart rate of a patient with a stethoscope. They are both Black women.

In a study of U.S. breast cancer survivors using the SEER registries, researchers observed that breast cancer survivors living in lower socioeconomic status and more rural counties at the time of their breast cancer diagnosis were at higher risk of dying from cardiovascular disease compared to those living in higher socioeconomic and more urban counties. This study was published in JNCI Cancer Spectrum on November 29, 2022.  

Breast cancer survivors have a higher cardiovascular disease mortality risk compared to individuals with no history of cancer, partly due to certain cardiotoxic cancer treatments. However, the increased risk varies across the U.S. To better understand these disparities, Jacqueline B. Vo, Ph.D., R.N., M.P.H., assistant clinical investigator in the Radiation Epidemiology Branch, led this study focusing on specific county-level factors (socioeconomic status, median income, and rurality). The research team included 2021 summer intern, Katherine L. Ho, M.P.H. 

The researchers found that breast cancer survivors living in lower socioeconomic counties at the time of diagnosis were at 41 percent higher risk of dying from cardiovascular compared to those living in higher socioeconomic counties. The increase in risk was 24 percent for rural compared to urban counties. The greatest relative disparities were found for younger women diagnosed before the age of 60, but women diagnosed after age 60 had the greatest absolute difference in cardiovascular disease mortality risk.  

These disparities are likely due to various barriers to healthcare access. This study identifies a public health need to identify resources and interventions to support the cardiovascular disease screening and treatment of medically underserved cancer survivor populations. Future work using individual-level data is needed to inform these multilevel efforts to reduce disparities. 


Ho KL et al. County-level geographic disparities in cardiovascular disease mortality among U.S. breast cancer survivors, 2000-2018JNCI Cancer Spectr. 2022.