Disadvantaged neighborhoods and racial disparity in breast cancer outcomes: the biological link

Abstract

Neighborhoods encompass complex environments comprised of unique economic, physical, and social characteristics that have a profound impact on the residing individual's health and, collectively, on the community's wellbeing. Neighborhood disadvantage (ND) is one of several factors that prominently contributes to racial breast cancer (BC) health disparities in American women. African American (AA) women develop more aggressive breast cancer features, such as triple-negative receptor status and more advanced histologic grade and tumor stage, and suffer worse clinical outcomes than European American (EA) women. While the adverse effects of neighborhood disadvantage on health, including increased risk of cancer and decreased longevity, have recently come into focus, the specific molecular mechanisms by which neighborhood disadvantage increase BC risk and worsen BC outcomes (survivorship, recurrence, mortality) are not fully elucidated. This review illuminates the probable biological links between neighborhood disadvantage and predominantly BC risk, with an emphasis on stress reactivity and inflammation, epigenetics and telomere length in response to adverse neighborhood conditions.

The Association Between Area Deprivation Index and Patient-Reported Outcomes in Patients with Advanced Cancer

“…It is well established that individuals from lower income households experience more cumulative lifetime stress such as chronic food and housing insecurity, fear for personal safety, and exposure to violence over a lifetime with a ''weathering'' effect that holds implication for health outcomes. 48 For advanced illness the Model of Neighborhood Material Wealth outlined by Stafford and Marmot 49 asserts that regardless of individual factors, neighborhoods of less deprivation (wealthier) offer their residents more tangible goods and services decreasing the stress of ''everyday life'' associated with advanced illness. Examples of these goods and services in advanced cancer care may be access to pharmacies with needed supplies and medications, more and better funded social support through faith-based and community groups, or supplementary patient-based home support (cleaning, child care, and transportation) through advocacy agencies and individuals within the community able to volunteer and offer support.…”

“…It is well established that individuals from lower income households experience more cumulative lifetime stress such as chronic food and housing insecurity, fear for personal safety, and exposure to violence over a lifetime with a “weathering” effect that holds implication for health outcomes. 48 …”

Cancer as a prospective sequela of long COVID‐19

“…The engendered stress causes the release of inflammatory mediators (e.g., CRP, IL‐6, NF‐κB, TNF‐α) via the activation of the sympathetic nervous system and the hypothalamic‐pituitary‐adrenal axis. [ 46 ] Continuous social and environmental stresses induce chronic inflammation that is at the root of most disease etiologies. Importantly, a higher prevalence of low‐grade inflammation has been shown in young AAs subjected to racial discrimination compared to those who identified positively with their racial identities.…”

“…[ 47 ] Environmental and social factors may also modulate epigenetic modifications (DNA methylation, histone modifications, and alterations in the expression of non‐coding RNAs), thereby affecting disease susceptibility. [ 46 ] Considering the higher levels of proinflammatory cytokines in AAs, a pronounced impact of COVID‐19 is comprehensible. It remains unclear, however, whether AAs are more susceptible to COVID‐19 sequelae, including cancer.…”

Visual cues of the built environment and perceived stress among a cohort of black breast cancer survivors

“…The persistent racial disparity has led to a greater focus on the potential role of psychosocial stress which might be involved in pathways leading to adverse breast cancer survival outcomes. ( Williams et al, 2016 ; Saini et al, 2019 ; Krieger, 2013 ).…”