ASO Author Reflections: Access to Healthcare Does Not Mean Access to Health: Food Deserts in the Land of Plenty
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ASO AUTHOR REFLECTIONS
ASO Author Reflections: Access to Healthcare Does Not Mean Access to Health: Food Deserts in the Land of Plenty Abigail J. Fong, MD1, Kelly Lafaro, MD2, and Yuman Fong, MD3 1
Department of Surgery, Cedars Sinai Medical Center, Los Angeles, CA; 2Department of Surgery, Johns Hopkins Hospital, Baltimore, MD; 3Department of Surgery, City of Hope Medical Center, Duarte, CA
PAST America is a land of wealth, yet 23 million Americans live in food deserts, defined as communities where the populace lives more than 10 miles from a grocery store in rural areas or more than a mile from a grocery store in urban areas.1 Past studies have linked distance from fresh fruit or fresh food to be associated with increased obesity, diabetes, heart disease, and early death.2 Many studies are underway to look at the causes of these poor health outcomes. Interventions have also been attempted to mitigate these poor health outcomes by putting markets and access to fresh food into deserts, with mixed results.3 PRESENT In the paper by Fong et al. entitled ‘‘Association of Living in Urban Food Deserts with Mortality from Breast and Colorectal Cancer’’, we linked cancer outcome data to residency in food deserts.4 The association between access to fresh food and cancer was investigated by using the California Cancer Registry to identify patients with stage II/III breast or colorectal cancer. The patient’s residence at the time of diagnosis was linked by census tract to food desert using the US Department of Agriculture’s Food Access Research Atlas. For both breast cancer and colorectal cancer, patients living in food deserts had poorer survival despite equal rates of treatment by surgery and
chemotherapy. Multivariable analyses showed that food desert residence was associated with mortality independent of diabetes, tobacco use, poor insurance coverage, or low socioeconomic status. FUTURE This study encourages future studies on modulating outcomes of cancer therapies by modifying metabolic parameters in the patients. An important step for facilitating prospective studies would be defining potential biomarkers of cancer outcomes, such as insulin resistance, proteomics, or exosomics to both serve as targets as well as endpoints for future interventional studies. Pollution maps, radiation maps, and poverty maps are also available for potential multi-cartographic analysis of cancer outcomes. There has long been a study of nutritional effects on cancer outcomes, mostly centered on malnutrition.5 Emerging data from the current study and other studies would imply obesity and insulin resistance are also possible causes of poor cancer outcomes. Most importantly, this paper represents additional data encouraging active intervention to eliminate food deserts if health and longevity for all Americans is a common goal. DISCLOSURES Yuman Fong is a scientific consultant for Medtronics, Johnson and Johnson, and Olympus, and has received royalties from Merck and Imugene. Abigail J. Fong and Kelly Lafaro have no disclosures to declare.
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