Redlined! Historical Redlining and Breast Cancer: The Alarming Connection that Needs to Be Addressed
By Helana Shumway, Public Relations Coordinator
In the 1930s, the Home Owners’ Loan Corporation (HOLC) was created during Franklin Delano Roosevelt’s presidency to make policies that would assist in mortgage lending following the Great Depression.1 The goal, on paper, was to help those struggling financially not to foreclose on their homes, but unfortunately, the consequences of HOLC led to what we know today as “redlining,” a policy that is fraught with structural racism.
HOLC created maps of cities, rating neighborhoods from an “A” grade down to a “D” grade. These grades were based on race, socioeconomic class, and land use, clearly reflecting segregation-based policies. Neighborhoods given an “A” or “B” grade tended to be more white with higher incomes and more residential buildings than commercial or industrial. Those with “C” or “D” grades were neighborhoods predominantly of color, poorer, and less residential, along with less greenspace. Redlining was a racist policy that discriminated against people of color and their access to mortgages and homeownership.
While this policy of redlining has long been outlawed,(2) its harm on neighborhoods and communities continues to be seen and felt today. Sarah Lima, PhD, MPH, is an epidemiologist who studies the connection between historically redlined communities and breast cancer. She received her doctorate from the University at Buffalo and has focused much of her research on New York cities that were redlined. Her research asserts that the structural racism set in place by redlining policies impacts present-day breast cancer survival rates and the prevalence of risk factors associated with the disease.
Redlining and Breast Cancer Survival
Source: Lima et al. CEBP, 2025. PMID: 40178940
Dr. Lima looked at 19 cities in New York State where redlining maps were created, including Buffalo, Rochester and Syracuse, along with many others. She analyzed nearly 61,000 breast cancer cases between 2008 – 2018 in the redlined cities (data available through the NYS Cancer Registry). Her research was guided by fundamental cause theory, which suggests that social inequities – such as lower socioeconomic status – are the root cause of health inequities and disparities.(3)
Based on the 19 New York cities studied, Dr. Lima found that historically redlined neighborhoods and present-day breast cancer survival rates were deeply connected. When compared to A-grade neighborhoods, living in a B-grade neighborhood resulted in a 29% higher risk of death from breast cancer. C-grade neighborhoods resulted in a 37% higher risk, and D-grade neighborhoods in an astonishingly 64% higher risk of breast cancer-related death.
To bring these stark findings home, Dr. Lima found that even after adjusting for race, ethnicity, stage, and hormone receptor status (risk factors that determine a lot regarding breast cancer survival), the significant mortality effect from D-grade neighborhoods persisted.
Additionally, Dr. Lima found that historically redlined neighborhoods were associated with prognostic factors for breast cancer. Those in A-grade neighborhoods had a higher likelihood of being diagnosed with breast cancer at an earlier stage and had higher rates of luminal A breast cancer – a type known to have more treatment options compared to others.(4) Those in D-grade neighborhoods were more likely to be diagnosed under age 40, had a higher risk of being diagnosed at a distant stage, and were more likely to be diagnosed with triple-negative breast cancer – an aggressive type known to have fewer treatment options.(5)
These findings are damning. As Dr. Lima succinctly summarizes, “Historical redlining grades are associated with progressively worse breast cancer survival today.”
This article appeared in the Winter 2026 newsletter, “Voices of the Ribbon.”
Redlining and Breast Cancer Risk Factors
Source: Lima et al. Cancer Causes Control, 2025.
A second study of Dr. Lima’s investigated the relationship between historical redlining and breast cancer risk factors. Through analyzing breast cancer risk and likelihood of survival based on neighborhood-level prevalence data across the United States, Dr. Lima aimed to examine whether risk factors associated with breast cancer “clustered” or commonly happened together based on a neighborhood’s historical redlining grade.
Breast cancer risk factors include (but are not limited to) rates of mammography, smoking, drinking alcohol, physical inactivity, exposure to pollution and access to health care.
Across the United States, Dr. Lima found that redlined neighborhoods have 34% more breast cancer risk factors present compared to non-redlined neighborhoods. There were differences by region across the country (Midwest, Northeast, South, West) in terms of the clustering of risk factors, but each region consistently showed at minimum a 30% increase in risk factors in redlined neighborhoods.
Dr. Lima’s research found that there were two types of clusters surrounding breast cancer risk factors: those related to behavioral and socioeconomic factors and those related to health care factors.
“We found that social and behavioral factors – [such as] alcohol drinking as well as obesity rates or things related to income levels or educational levels – those tended to group together, whereas health care-related factors tended to group together,” explains Dr. Lima.
“And when we checked across those, we found that overall, in the U.S., it’s really the social and behavioral factors that tend to be most frequently agreeing with that redlining basis. So, the idea essentially being that for most places, you would want to target a social and behavioral intervention, whereas if you were to increase the mammography rates, we probably wouldn’t see these disparities reducing.”
Understanding that social and behavioral risk factors tend to cluster in redlined neighborhoods is essential, indicating that addressing concerns like lower income levels or food deserts (meaning there are no nearby grocery stores or markets) may be needed more than health care factors like increasing mammography screenings.
Looking Ahead: Policy-Level Change
With Dr. Lima’s research clearly connecting historical redlining to present-day breast cancer disparities, the question now is: what can be done, and how do we get there? As Dr. Lima says, “I think we ultimately need policies to change it.”
For example, environmentally-based policies, like the removal of highways that often cut through low-income neighborhoods, would likely lower air pollution levels, says Dr. Lima. The land could then be refurbished for parks or greenspace.
Social and economic policies could look like tax credits, which Dr. Lima says, “… can be really useful in preventing the poverty consequences to health.” This could lessen the burden of food insecurity, for example, such as not having to choose between feeding one’s family and paying for cancer treatment.
Dr. Lima has a recently published study that looked at neighborhood socioeconomic status and breast cancer mortality risk (Lima et al., Am. J. Epidemiol., 2025). By performing a simulated intervention, Dr. Lima discovered profound results: “We found evidence that improving the neighborhood socioeconomic status would probably reduce these [redlining] disparities in half.”
An additional recent study of Dr. Lima’s shows promising results that indicate disparities in breast cancer mortality rates in redlined neighborhoods have narrowed over time, meaning that these disparities can change (Lima et al., Cancer, 2026). As Dr. Lima explains, “If [the mortality rate] changes over time, that means we can impact it, and it is something intervenable.”
A goal to strive toward, says Dr. Lima, could be to design a neighborhood not based on property value, but rather by what would make it the healthiest environment.
Real policy change is essential to address the lasting impacts of historical redlining on breast cancer disparities. While Dr. Lima’s research consists of observational studies in which the results cannot be interpreted causally, the significance of her findings is indicative of much needed policy-level interventions that will begin to address systemic racism in breast cancer incidence and mortality.
Dr. Lima’s Citations:
- Lima, Sarah M et al. “Historical Redlining and All-Cause Survival after Breast Cancer Diagnosis.” Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology vol. 34,6 (2025): 904-913. doi:10.1158/1055-9965.EPI-24-1862
- Lima, Sarah M et al. “Historical redlining and clustering of present-day breast cancer factors.” Cancer causes & control : CCC vol. 36,5 (2025): 483-495. doi:10.1007/s10552-024-01950-9
- Lima, Sarah M., et al. “Historical redlining, breast cancer survival, and the mediating and modifying role of contemporary neighborhood socioeconomic conditions.” American Journal of Epidemiology (2025): kwaf282.
- Lima, Sarah M et al. “The effect of time on associations between historical redlining and breast cancer survival.” Cancer vol. 132,4 (2026): e70230. doi:10.1002/cncr.70230
Additional Citations:
- https://dsl.richmond.edu/panorama/redlining
- https://www.federalreservehistory.org/essays/redlining
- Link, B G, and J Phelan. “Social conditions as fundamental causes of disease.” Journal of health and social behavior vol. Spec No (1995): 80-94.
- https://www.bcrf.org/about-breast-cancer/luminal-a-breast-cancer/
- https://www.cancer.org/cancer/types/breast-cancer/about/types-of-breast-cancer/triple-negative.html
This article first appeared in the Coalition’s publication, “Voice of the Ribbon,” Spring 2026 issue.
