WILMINGTON, DE — A groundbreaking study by ChristianaCare’s Cawley Center for Translational Cancer Research has identified key factors behind Delaware’s elevated rates of advanced breast cancer and laid the groundwork for more targeted, data-driven interventions.
Published this week in JNCI Cancer Spectrum, the research builds on prior findings that identified two geographic clusters with unusually high rates of late-stage breast cancer—in Wilmington and Middletown. The new study dives deeper, revealing what’s driving those disparities and how health systems can respond.
“This is how we close gaps in outcomes—by figuring out not just who is affected, but where and why,” said Dr. Scott Siegel, the study’s lead author and director of Cancer Control & Population Sciences at the Cawley Center.
The team manually reviewed nearly 3,500 patient records from 2012 to 2020, creating a dataset that included screening history, method of detection, tumor grade, and molecular subtype. The results confirmed that reduced screening rates and a higher prevalence of triple-negative breast cancer (TNBC) in Wilmington fully explained the area’s elevated incidence of advanced disease.
Delaware already ranks among the highest states for late-stage breast cancer diagnoses and holds the top spot nationally for TNBC, a particularly aggressive form of the disease that resists traditional hormone treatments.
By mapping cancer risk data down to the neighborhood level, researchers identified the Wilmington hotspot as a convergence of low screening rates and high TNBC incidence. In response, ChristianaCare has embedded a community health worker in the area to boost screening and deliver personalized prevention services, including risk assessments and connections to targeted programs.
“This research highlights the power of data to guide better cancer care,” said Dr. Thomas Schwaab, medical director of the Helen F. Graham Cancer Center & Research Institute. “By linking screening behavior, tumor biology, and location, we’re creating a precision prevention model that could be replicated far beyond Delaware.”
In Middletown, the analysis revealed a troubling trend among younger women, with many diagnosed before age 50. While screening and tumor aggressiveness were again factors, they accounted for only half the elevated risk, suggesting other variables—such as environmental exposures or demographic shifts—may be involved. Researchers are now investigating further.
The implications extend beyond Delaware. The study argues for broader adoption of “catchment area” analysis—currently required only at major National Cancer Institute-designated centers—to be implemented in community cancer centers, where the majority of U.S. patients receive care.
“If we want to make real progress, this kind of work has to happen where most patients actually receive their care,” said Dr. Nicholas Petrelli, director of the Cawley Center. “That’s what we’re doing here, and it’s making a difference.”
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