ChristianaCare Research Pinpoints Drivers Behind Advanced Breast Cancer in Delaware Hotspots
Research can serve as a model for community-based cancer centers nationwide
A new study from ChristianaCare’s Cawley Center for Translational Cancer Research at the Helen F. Graham Cancer Center & Research Institute sheds new light on why certain areas of Delaware face higher odds of advanced breast cancer and offers a path forward to reduce that burden.
The study, published in JNCI Cancer Spectrum on July 22, builds on earlier research that identified two geographic hotspots for advanced breast cancer in Wilmington and Middletown. The new analysis explains what’s driving those elevated rates and how that knowledge is 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 paper represents more than a year of work and thousands of hours of data collection. The research team manually reviewed nearly 3,500 medical records to create a first-of-its-kind dataset that includes method of detection, time since last screening, tumor grade and molecular subtype.
“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.”
Identifying targets for intervention
The patient data came from the cancer registry at the Graham Cancer Center, which identified 3,492 women diagnosed with invasive breast cancer between 2012 and 2020.
“This is how we close gaps in outcomes: by figuring out not just who is affected, but where and why.” – Scott Siegel
“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 highest states in the country for incidence of late-stage breast cancer and is the highest in the nation for incidence of triple-negative breast cancer (TNBC), an aggressive subtype that does not respond to standard hormonal therapies.
The power of data to guide care
By mapping cancer data down to the level of patient addresses, researchers showed how the Wilmington hotspot sits at the intersection of two other mapped risk zones: one with high rates of TNBC and another where women are less likely to get regular breast cancer screenings.
“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 begun to act. A community health worker is now embedded in the Wilmington hotspot to increase screening and conduct breast cancer risk assessments. Residents at higher risk will be connected to prevention programs, including those 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 study found a high number of advanced breast cancer cases among women under age 50. Here, too, screening gaps and aggressive tumor characteristics were factors, but they explained only 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.”
A national model from a community cancer center
The study sends a clear message that community cancer centers can lead the way in improving cancer outcomes by focusing efforts where the risk is highest. With the right data, they can target outreach, expand screening and deliver resources to the neighborhoods that need them most.
“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.”