How structural racism affects triple-negative breast cancer risk

Certain choices, such as exercising, smoking, or drinking, can affect your health. But there aren’t many known risk factors for triple-negative breast cancer (TNBC) that you can control.

This aggressive type of cancer often occurs in people younger than the average person with breast cancer. Black and Latina women also get TNBC more often than other groups. The reasons are not entirely clear, and they are surely complicated. But emerging evidence suggests some answers can be found in a long history of racially discriminatory practices and policies — and the many ways they continue to shape our communities.

“We believe that all of these separate risks work together to increase the incidence [of TNBC in some groups compared to others]says Scott Siegel, PhD, psychologist and director of population health at ChristianaCare. “They can add up or maybe multiply in terms of impact on [TNBC] risque.”

How do prejudice and structural racism affect triple-negative breast cancer rates?

Siegel recently published a study on racial disparities in TNBC. He became interested in this aggressive form of breast cancer based on previous findings that white and black people get breast cancer at a similar rate. But black people are 40% more likely to die from it.

About half the reason, he says, is that the rate of TNBC is higher in black women. About 10-15% of all breast cancers are TNBCs. TNBC more often spreads before a doctor finds it. It’s also harder to beat. The 5-year survival rate for TNBC that has spread is 12%. That’s compared to 29% for other forms of metastatic breast cancer. (The survival rate is the percentage of people with the same type and stage of cancer who are still alive a certain amount of time — usually 5 years — after diagnosis.)

To understand racial disparities in incidence and outcome, “the traditional approach looks at individual risk factors,” says Siegel. “But research in general shows that where people live has a lot to do with their health. Everything from neighborhood income to access to healthy food to air quality.

He wanted to know what puts some people at greater risk for TNBC than others. Racial segregated neighborhoods mean that differences between neighborhoods add to racial disparities. Structural racism – or all the ways in which discrimination is applied in housing, education, employment, income, health care, etc. – shapes these distinctions.

“You see big differences in neighborhoods,” Siegel says. “Neighborhoods are exposed to many different risks. It’s hard to watch one exhibit at a time. We try to have a global vision.

Linking structural racism to breast cancer outcomes

Siegel focused on more than 3,300 women with breast cancer in a particular county in Delaware from 2012 to 2020. This is an area known to have more cases of TNBC than other places. While other studies had looked at economic differences, Siegel was more interested in segregation.

He says the data showed that predominantly black neighborhoods had a higher risk of TNBC than predominantly white neighborhoods. And the differences could not be explained by race. Even when they took race differences into account, they still saw a neighborhood effect.

The results suggest that the environment in predominantly black neighborhoods differs in ways that increase the risk of TNBC. They imply that historical policies and practices that have led to racially segregated communities have led to enduring health disparities.

These may stem from a range of factors, including easier access to health care in some neighborhoods and easier access to fast food restaurants and liquor stores in others. Siegel found more stores selling alcohol and unhealthy foods in predominantly black neighborhoods with more TNBC cases. They also had more obesity and alcohol use disorders.

While segregation is no longer the law, says Siegel, “a whole bunch of other processes have more or less kept communities the way they are. Segregated minority communities have not had access to investment over the years. They have less access to resources that promote health, such as grocery stores and stable housing, but are more exposed to air pollution and liquor stores. We believe the most upstream factor is structural racism.

Lasting effects of history and racial disparities in the TNBC

In another study, Jesse Plascak, PhD, an epidemiologist at Ohio State University, investigated the effects of discriminatory mortgage lending practices, or redlining, of the 1930s and their link to breast cancer outcomes by race today. today. The idea was that these lending practices, illegal for decades, could still affect communities in ways that produce health disparities.

“The idea is not that those people diagnosed with breast cancer were directly affected by these practices,” he says. “Most of them weren’t born yet. But these are places that had a differential investment of resources and other characteristics that may be present today due to these structural racist practices in the 1930s and 1940s.”

The study included nearly 15,000 women with breast cancer, including thousands who identified as Latina, non-Latin Black and non-Latin White. They found that women living in areas that had not been demarcated or discriminated against in the past had better breast cancer outcomes. But that was only true when women identified as white. Among other differences, women with breast cancer who lived in areas without redlining in the past had TNBC less often.

“These effects can be long-lasting,” says Plascak. “They shape places; they shape people. People can move or stay, but they themselves shape places in terms of invested or uninvested resources.

What does this mean for me?

Plascak says he wants to learn more about how these practices lead to differences in cancer types and outcomes more specifically. “There’s not much we can do about something that happened 100 years ago,” he says. “But if we can understand that it’s causing something today that we can change, then we should focus on that.”

Siegel is also interested in exploring how to “translate results into action” with the goal of reducing disparities. To begin with, it aims to share the results with policy makers and the public.

“There are absolutely steps we can take right now to make neighborhoods healthier,” he says. “We don’t have to accept these disparities. This is the most important thing. When you can point to structural factors, we now have intervention objectives, and we can address them. »

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