ChristianaCare study maps breast cancer risks in Delaware hotspots, guides targeted prevention

The map highlights two Delaware hotspots—Wilmington and Middletown—where advanced breast cancer rates are elevated. In Wilmington, the overlap with poor screening rates and aggressive cancer types suggests a combined impact. In contrast, Middletown’s elevated cases occur without such overlaps, indicating other contributing factors. (photo provided by Christianacare)

A new study from ChristianaCare’s Cawley Center for Translational Cancer Research at the Helen F. Graham Cancer Center & Research Institute is offering new insight into why some parts of Delaware see higher rates of advanced breast cancer and how to reduce that burden.

Published July 22 in JNCI Cancer Spectrum, the study builds on previous research that pinpointed two geographic hotspots for advanced breast cancer: Wilmington and Middletown. The new analysis delves into the underlying causes and is already shaping ChristianaCare’s clinical response.

“What sets this study apart is the depth of data and the precise geographic focus,” said Scott Siegel, Ph.D., lead author and director of Cancer Control & Population Sciences at the Cawley Center. “This is how we close gaps in outcomes: by figuring out not just who is affected, but where and why.”

The research team reviewed nearly 3,500 medical records over a period of more than a year, creating a unique dataset that includes the detection method, time since last screening, tumor grade, and molecular subtype. The results shed light on distinct contributing factors in each hotspot.

“This work allowed us to get a much clearer picture of what’s driving risk in these communities,” Siegel said. “Wilmington is our first test case, but the long-term goal is to use this approach to turn breast cancer hotspots in Delaware stone cold.”

The map generated by the study illustrates areas where screening is less consistent. It highlights how Wilmington overlaps with regions of poor screening and aggressive cancer types, suggesting a direct link. In contrast, Middletown did not overlap with these other hotspots, implying different causes may be at play.

The patient data, gathered from the cancer registry at the Graham Cancer Center, included 3,492 women diagnosed with invasive breast cancer between 2012 and 2020.

“In Wilmington, we found that reduced screening rates and a higher prevalence of triple-negative breast cancer fully explained the excess cases,” said Siegel. “That’s significant – it means we have identifiable, actionable targets for intervention.”

Delaware ranks among the top states for late-stage breast cancer incidence and leads the nation in cases of triple-negative breast cancer (TNBC), an aggressive form that doesn’t respond to standard hormonal treatments.

By mapping cancer risks to the level of patient addresses, the study identified how the Wilmington hotspot intersects with zones showing both poor screening rates and elevated TNBC cases.

“This research highlights the power of data to guide better cancer care,” said Thomas Schwaab, M.D., Ph.D., Bank of America Endowed Medical Director of the Helen F. Graham Cancer Center & Research Institute. “By connecting what we know about tumor biology and screening patterns with where people live, we’re able to focus prevention efforts more precisely. That’s a model that can be applied well beyond Delaware.”

ChristianaCare has already started acting on these findings by embedding a community health worker in the Wilmington hotspot. This role includes promoting screenings, conducting risk assessments, and linking at-risk residents to prevention programs, including those tailored for TNBC.

“We’re using a precision health model and concentrating intensive prevention resources exactly where they’re needed,” Siegel said. “Wilmington is our first test case, but the goal is to expand this approach across other hotspots in New Castle County and downstate.”

In Middletown, the data revealed a notable number of advanced breast cancer cases among women under 50. While some were linked to screening lapses and aggressive tumor traits, those factors only explained about half the cases.

“This points to the likelihood of other factors, possibly environmental or related to population shifts, playing a role,” said Siegel. “We’re actively investigating that now.”

The findings underscore the ability of community cancer centers to drive change by zeroing in on high-risk areas with data-driven precision.

“Catchment area analysis is currently required only at National Cancer Institute-Designated Cancer Centers,” said Nicholas J. Petrelli, M.D., director of ChristianaCare’s Cawley Center for Translational Cancer Research. “But 85% of cancer care happens outside those major academic centers in the catchment areas of community cancer centers, like ours.

“If we want to make real progress, this kind of work has to happen where most patients actually receive their care. That’s what we’re doing here, and it’s making a difference.”