Linking Structural Racism and Discrimination and Breast Cancer Outcomes: A Social Genomics Approach

Abstract

Society to Cells to OutcomesWe live in a society where individuals and communities are marginalized because of their race or ethnicity. This structural inequity extracts enormous health and societal costs, decreasing access to cancer care and increasing health disparities, especially among the most vulnerable. In an effort to identify causes of disparities, we have incorporated individual sociodemographic characteristics (eg, income and education) and other social determinants of health (eg, access to care, insurance, and transportation needs), as well as biologic markers (eg, genetic predisposition to disease) that can serve as therapeutic targets into our research.Author affiliations and support information (if applicable) appear at the end of this article.

Association Between Residence in Historically Redlined Districts Indicative of Structural Racism and Racial and Ethnic Disparities in Breast Cancer Outcomes

“…Potential biologic mechanisms underpinning relationships involving breast cancer outcomes, self-identified race and ethnicity, and interpersonal and structural racism could involve chronic psychosocial stress and genomic markers of inflammation (eg, DNA methylation or gene expression of interleukin receptors, C-reactive protein). 43 , 44 , 45 Empirical studies designed explicitly to test whether stress and genomic inflammatory markers mediate associations between racism and breast cancer are lacking. However, one study has reported differential breast tumor methylation of numerous genes by neighborhood socioeconomic factors, with at least 1 such gene also correlating with mortality following a breast cancer diagnosis.…”

“… 41 , 42 Stress and inflammatory pathways have been proposed as possible biologic mediators between racism and health outcomes, including breast cancer outcomes, and potential contributors to racial and ethnic disparities. 1 , 43 , 44 , 45 Accordingly, this study investigates associations between 1930s-era HOLC redlining, racial and ethnic identity, and breast cancer stage, grade, TNBC, and mortality among women diagnosed between 2008 and 2017 while a resident of a metropolitan area of New Jersey.…”

“…Moreover, to our knowledge, there is no literature reporting on associations between redlining and breast tumor grade or triple-negative breast cancer (TNBC)—both clinically relevant outcomes potentially influenced by social factors and which exhibit variation by race and ethnicity . Stress and inflammatory pathways have been proposed as possible biologic mediators between racism and health outcomes, including breast cancer outcomes, and potential contributors to racial and ethnic disparities . Accordingly, this study investigates associations between 1930s-era HOLC redlining, racial and ethnic identity, and breast cancer stage, grade, TNBC, and mortality among women diagnosed between 2008 and 2017 while a resident of a metropolitan area of New Jersey.…”

Social Genomics as a Framework for Understanding Health Disparities Among Adolescent and Young Adult Cancer Survivors: A Commentary

“…Biologic and social environmental factors interact to affect cancer outcomes across all ages of cancer survivors. A social genomics approach to outcomes research in cancer suggests a biologic component of psychological and social influences on disease by identifying neural and molecular pathways through which psychological and social factors mechanistically influence disease development and progression (see general reviews 10,14 and cancer-specific reviews 13,[15][16][17]. Figure 1 shows a conceptual framework of social genomics in cancer survivorship by which biologic mechanisms and gene expression attenuate the effects of specific psychological and social risk and resilience factors (eg, poverty, exposures to trauma, social isolation, behavioral self-efficacy, and meaning attribution) on health outcomes and QOL for cancer survivors.…”

Factors associated with ductal carcinoma in situ (DCIS) treatment patterns and patient-reported outcomes across a large integrated health network

“…Numerous studies have reported significant disparities in cancer care arising from sociodemographic characteristics and other social determinants of health [ 11 – 16 ]. DCIS has been also reported disparities in outcomes [ 13 , 14 ]. However, DCIS treatment patterns according to patient characteristics and treatment locations have not been clearly elucidated or assessed.…”