A retrospective study of 943 patients with locally advanced breast cancer treated with comprehensive nodal irradiation between 2016 and 2023 concludes that living in a food-insecure area is associated with worse overall survival, despite similar cancer treatments and comparable treatment adherence.
What was known
People living in food-insecure areas (a sustained difficulty in accessing sufficient, nutritious food) have worse cancer outcomes. Previous studies had not established whether these inequalities stemmed from differences in tumor characteristics, treatment delivery, adherence, or food insecurity itself.
What this work adds
This is a retrospective analysis of 943 patients with locally advanced breast cancer treated with comprehensive nodal irradiation between 2016 and 2023. Demographic, clinical and treatment variables were compared using chi-squared and Mann-Whitney tests, and overall survival was assessed with Kaplan-Meier analysis and multivariable Cox regression models. Median follow-up was 25.0 months for non-food-insecure-area residents and 28.8 months for residents of such areas.
Main results
Residents of food-insecure areas (n = 60; 6.4%) were more likely to identify as Black (P < .001) and to have comorbidities such as hypertension (P < .001), diabetes mellitus (P < .001) and higher ECOG performance status (P < .001). Categorical obesity rates did not differ at baseline (57.4% vs 42.3%; P = .153) but diverged significantly by follow-up (65.5% vs 40.9%; P < .001). Cancer and treatment characteristics did not differ between groups. In multivariable analysis, food insecurity (HR 5.52; 95% CI 1.76-17.27), diabetes mellitus (HR 2.96; 95% CI 1.13-7.76) and new pulmonary conditions at follow-up (HR 9.57; 95% CI 3.46-26.49) were independent predictors of mortality; hormone therapy delivery and duration were protective. Five-year overall survival was 74.9% for residents of food-insecure areas versus 90.2% for the rest (P = .005).
What it means
The work describes a food insecurity-obesity paradox: food insecurity behaves as an independent predictor of mortality even when tumor and treatment are comparable, and obesity increased more in that group after treatment. The authors argue that interventions must address nutritional quality and food access, not only oncology care. The association is observational and does not prove causation.
Reference: Thompson AD, Escobal LHD, Mathai M, Singh G, Koduri S, Ferris MJ, et al. Food Insecurity and Overall Survival in Locally Advanced Breast Cancer Patients Receiving Comprehensive Nodal Irradiation: The Food Insecurity-Obesity Paradox. Advances in Radiation Oncology, 2026. DOI.
