社区代表着复杂的环境，具有独特的社会、文化、物质和经济属性，对健康、疾病和生存方面的差异产生重大影响。社区劣势与较短的乳腺癌无复发生存期 (RFS) 相关，与个人层面（种族、民族、社会经济地位、保险、肿瘤特征）和卫生系统层面的健康决定因素（接受符合指南的治疗）无关。这种 RFS 持续存在的差异表明了一些未解释的机制，例如与优势社区相比，生活在贫困社区的女性的肿瘤生物学更具侵袭性。本文的目的是为邻里劣势如何影响癌症生存提供清晰的框架和生物机制解释。开发一个转化流行病学框架，采用转化差异方法，通过社会基因组学和社会表观基因组学的视角来研究癌症结果差异。健康的社会基因组决定因素，定义为生理基因调控途径（即基因表达和表观遗传过程的神经/内分泌控制），通过该途径环境因素，特别是邻居，可以影响癌症基因组和周围肿瘤微环境的活性，从而改变疾病进展和治疗结果。我们提出了一种新颖的多层次健康决定因素模型，该模型采用转化流行病学方法来评估政治、卫生系统、社会、心理社会、个人和社会基因组健康决定因素之间的相互作用，以了解健康的社会差异肿瘤学结果。在此过程中，我们提供了一条具体的生物学途径，社会过程和社会流行病学的影响通过该途径影响癌症的基本生物学，并最终影响临床结果和生存。

Neighborhoods represent complex environments with unique social, cultural, physical, and economic attributes that have major impacts on disparities in health, disease, and survival. Neighborhood disadvantage is associated with shorter breast cancer recurrence-free survival (RFS) independent of individual-level (race, ethnicity, socioeconomic status, insurance, tumor characteristics) and health system-level determinants of health (receipt of guideline-concordant treatment). This persistent disparity in RFS suggests unaccounted mechanisms such as more aggressive tumor biology among women living in disadvantaged neighborhoods compared with advantaged neighborhoods. The objective of this article was to provide a clear framework and biological mechanistic explanation for how neighborhood disadvantage affects cancer survival.Development of a translational epidemiological framework that takes a translational disparities approach to study cancer outcome disparities through the lens of social genomics and social epigenomics.The social genomic determinants of health, defined as the physiological gene regulatory pathways (ie, neural/endocrine control of gene expression and epigenetic processes) through which contextual factors, particularly one's neighborhood, can affect activity of the cancer genome and the surrounding tumor microenvironment to alter disease progression and treatment outcomes.We propose a novel, multilevel determinants of health model that takes a translational epidemiological approach to evaluate the interplay between political, health system, social, psychosocial, individual, and social genomic determinants of health to understand social disparities in oncologic outcomes. In doing so, we provide a concrete biological pathway through which the effects of social processes and social epidemiology come to affect the basic biology of cancer and ultimately clinical outcomes and survival.