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2025
JAMA Netw Open
In a cross-sectional study involving Black and White women participating in the NCI Maryland Breast Cancer Study, the investigators examined associations between neighborhood-level deprivation, air pollution (PM₂.₅) and presence of breast tissue crown-like structures (CLS-B) plus DNA methylation patterns. Higher PM₂.₅ exposure and greater neighborhood deprivation were associated with increased odds of having CLS-B (OR for PM₂.₅ 2.32, 95% CI: 1.12–4.78). The findings point to how socio-environmental disadvantage and pollution may influence breast adipose inflammation and epigenetic changes linked to cancer risk.
2025
J Clin Oncol
A large California study of over 58,000 racially and ethnically diverse women found that long-term exposure to fine particulate matter (PM2.5) air pollution was associated with a statistically significant 28% increased risk of breast cancer for each 10 μg/m³ increase in PM2.5 concentration, with the association consistent across African American, Latino, and other ethnic groups. When combined with data from 10 other studies in a meta-analysis, PM2.5 exposure showed a borderline significant 5% increased breast cancer risk, providing strong evidence that air pollution is an important breast cancer risk factor. These findings emphasize that breast cancer prevention strategies should extend beyond individual lifestyle changes to include population-level policies aimed at reducing air pollution, particularly as traditional risk factors explain only half of breast cancer cases and incidence continues to rise globally.
2025
Int J Environ Health Res
In this case-control study of African American women in Memphis, 355 participants aged 20–88 were enrolled, and the final analysis included 50 breast cancer cases and 157 controls whose home addresses were linked to detailed environmental and socioeconomic data. Using logistic regression, the researchers found that women living closer to heavy traffic had higher odds of breast cancer (OR 1.64, 95% CI: 1.05–2.56), and those living nearer to Superfund hazardous waste sites had markedly higher odds (OR 12.26, 95% CI: 1.81–82.86) compared with women living farther away. Spatial mapping showed that cases clustered in Southwest Memphis, an area with higher environmental burden and disadvantage. These findings suggest that environmental inequities in the built and industrial environment may substantially contribute to breast cancer disparities among African American women in this region.
2024
Environ Health Perspect
A nationwide study using CDC biomonitoring data found that California’s Proposition 65, which requires warnings about chemicals that cause cancer or reproductive harm, led to reduced exposures to listed chemicals across the entire United States, not just California. While blood and urine concentrations of 37 monitored chemicals generally declined over time, the researchers found evidence of problematic chemical substitution—for example, after bisphenol A (BPA) was listed, its concentrations dropped 15% but levels of the unlisted substitute bisphenol S (BPS) increased 20%. Californians generally had lower levels of harmful chemicals in their bodies compared to residents of other states, suggesting the law had additional protective effects. The findings indicate that transparency laws like Prop 65 can drive manufacturers to reformulate products nationwide, but regulations need to address entire chemical classes rather than individual substances to prevent companies from simply switching to similar but unlisted toxic chemicals.
2023
Environ Res
A nationwide U.S. study of nearly 45,000 women found clear geographic patterns in breast cancer rates, with lower risk in the South and Southeast and higher risk in the Northwest and parts of the Midwest and Northeast, even after accounting for personal risk factors like family history and reproductive factors. Environmental exposures—including air pollution (nitrogen dioxide and fine particles), light at night, greenspace, and neighborhood socioeconomic disadvantage—explained 21% of the geographic variation in overall breast cancer and 63% of the variation specifically for estrogen receptor-positive (ER+) breast cancer. These findings provide strong evidence that where you live matters for breast cancer risk, with environmental factors playing a substantial role, particularly for ER+ breast cancer, the most common subtype, suggesting that reducing environmental exposures like air pollution and light at night could be effective prevention strategies at the community level.
2022
Ann Surg
A genomic study of 308 women with stage I-IV breast cancer (non-Hispanic White, Hispanic White, Hispanic Black, and non-Hispanic Black) using peripheral blood analysis found that increasing West African (WA) ancestry was associated with 6% higher odds of triple-negative breast cancer per percentage increase (OR = 1.06; 95% CI: 1.001-1.126) and higher neighborhood socioeconomic status (nSES) showed a protective effect (OR = 0.343; 95% CI: 0.151-0.781), though WA ancestry’s association with TNBC was attenuated when adjusting for nSES. Local ancestry analysis revealed nSES-independent enriched WA ancestral segments at specific chromosomal loci (χ²=42004914, p=3.70×10⁻⁵) associated with TNBC, while multinomial logistic regression demonstrated that women from low nSES neighborhoods remained more likely to have TNBC independent of genetic ancestry. These findings reveal the complex interplay between genetic ancestry and socioeconomic environment in TNBC etiology: while specific genetic variants linked to West African ancestry contribute to TNBC risk through biological mechanisms, neighborhood socioeconomic disadvantage exerts independent effects, highlighting that both genetic susceptibility and environmental/social determinants contribute to the disproportionate TNBC burden in Black women and underscoring the critical importance of studying gene-environment interactions as drivers of aggressive breast cancer disparities.
2020
Cancer Epidemiol
A study of 186,981 postmenopausal women in the NIH-AARP Diet and Health Study found that those living in areas with the highest levels of outdoor light at night (LAN) had a 10% increased risk of developing breast cancer over 16 years of follow-up compared to women in the darkest areas. The association was stronger for estrogen receptor-positive breast cancer (12% increased risk) and appeared to vary by individual characteristics such as smoking, alcohol consumption, sleep duration, and body mass index. These findings suggest that nighttime light pollution may disrupt circadian rhythms and contribute to breast cancer development, particularly hormone-sensitive tumors. The results highlight artificial light at night as a potentially modifiable environmental risk factor for postmenopausal breast cancer, with implications for urban planning and outdoor lighting policies.
2018
Discov Oncol
This systematic review examined the relation of 4 neighborhood factors on breast cancer incidence and prognosis among African-American women: neighborhood socioeconomic status (nSES), residential segregation, spatial access to mammography, and residential pollution. The authors found that nSES, residential segregation and access to mammography were all related to stage at diagnosis, and nSES and living in more segregated areas were both associated with mortality. Residential pollution was not associated with increased risk of breast cancer in the studies reviewed.
2025
JAMA Netw Open
A cross-sectional study of 121 Black and White women with breast cancer found that chronic stressors—including perceived stress, inadequate social support, discrimination, and neighborhood deprivation—were associated with harmful immune and tumor changes, with particularly pronounced effects in Black women who also lived in significantly more socioeconomically deprived neighborhoods. Higher stress, discrimination, and neighborhood deprivation were linked to increased systemic inflammation, immune-suppressive tumor environments (including tumor-promoting M2 macrophages), and elevated tumor mutational burden, while greater social support was associated with beneficial immune-stimulatory changes including increased natural killer cells in breast tissue. Black women showed distinct stress-related immunologic signatures including enhanced chemotaxis, immune suppression at the systemic level, and increased tumor-associated myeloid cells, suggesting that chronic psychosocial and environmental stressors may biologically contribute to breast cancer disparities by creating a pro-tumorigenic immune environment—findings that underscore the urgent need for interventions addressing social determinants of health as cancer prevention strategies.
2024
Cancer Causes Control
A population-based study using Kentucky cancer registry data (77,637 breast cancer and 56,598 colorectal cancer cases) found that higher ambient air concentrations of carcinogenic metals—cadmium, arsenic, nickel, and chromium(VI)—were associated with increased odds of residing in breast and colorectal cancer hotspots, independent of individual risk factors including age, race, smoking, and neighborhood socioeconomic characteristics. Cancer hotspot populations were disproportionately Black and exhibited markers of lower socioeconomic status, and importantly, the metal-cancer associations persisted even after adjusting for these factors, suggesting environmental metal exposure is an independent contributor to geographic cancer clustering. These findings provide evidence that historically marginalized communities face disproportionate exposure to carcinogenic metals through environmental pollution, likely contributing to cancer disparities, and underscore the urgent need for environmental justice interventions including stricter air quality regulations, cleanup of contaminated sites, and individual-level exposure assessments to fully understand how metal exposures drive cancer inequities in vulnerable populations.
2024
Healthcare
This article highlights the disparities in the treatment of breast cancer based on various demographic factors. In terms of prevention and screening, people of minority groups such as African American and Hispanic women face challenges in accessing preventative measures like mammograms, mostly because of inequitable access to healthcare, financial constraints, and inadequate insurance coverage. These disparities also lead to delayed diagnoses and therefore worse outcomes in the treatment of these cancers. Additionally, provider bias, patient mistrust in the healthcare system, and systemic inequalities in the healthcare infrastructure cause inefficient treatment of breast cancer in these minority groups as well.
2024
Environ Int
A study of 1,031 pregnant women from the socioeconomically diverse CANDLE cohort in the urban South found that ultra-processed foods constituted 38.6% of participants’ diets on average, with each 10% higher dietary proportion of ultra-processed foods associated with 13.1% higher urinary concentrations of DEHP phthalate metabolites, while specific foods like hamburgers, French fries, soda, and cake showed 6-10.5% higher DEHP per standard deviation increase in consumption. Causal mediation analyses revealed that lower income and education levels were associated with 1.9% and 1.4% higher DEHP exposure respectively, mediated through increased ultra-processed food consumption, indicating that ultra-processed foods contribute to socioeconomic disparities in phthalate exposure during pregnancy. The findings demonstrate that consuming ultra-processed foods increases exposure to endocrine-disrupting phthalates from food contact materials, and because socioeconomic barriers can prevent dietary modifications, policies to reduce phthalates in food packaging and processing are needed rather than relying solely on individual dietary recommendations to reduce prenatal phthalate exposures.
2024
Int J Mol Sci
This comprehensive review covers breast cancer biology from classification and risk factors through diagnosis and treatment, highlighting how the disease varies by subtype and between racial groups. The review examines both traditional factors like staging systems and molecular subtypes (Luminal A/B, Triple Negative, HER2-enriched) as well as emerging research on genetic mutations, epigenetic changes, and microbiome imbalances that may contribute to breast cancer development and progression. Recent evidence suggests that disruptions in the body’s microbial communities may play a role in breast cancer, with patterns potentially differing across populations, adding a new dimension to understanding racial disparities in breast cancer outcomes.
2023
Cancer Causes Control
A review examining how low socioeconomic status (SES) contributes to early chronic disease onset and reduced life expectancy found that neighborhood-level factors—including environmental pollutants, deprivation, social isolation, structural racism, and discrimination—create chronic life stress that affects molecular processes like DNA methylation, inflammation, and immune response, contributing to more aggressive tumor biology, particularly in Black Americans. Despite decades of research showing associations between neighborhood factors and cancer outcomes in marginalized communities, the biological mechanisms linking SES to cancer disparities remain poorly understood, though emerging evidence suggests chronic stress pathways may play a central role. The authors summarize current methods for measuring neighborhood-level deprivation, discrimination, and structural racism in cancer disparities research and recommend adopting a multi-faceted intersectional approach to reduce cancer health inequities and develop effective interventions promoting health equity.
2023
JAMA Oncol
A retrospective analysis of 60,137 women with early-stage, ER-positive, node-negative breast cancer found that Black women had an 82% increased risk of breast cancer death compared to White women, with social determinants of health (neighborhood disadvantage and insurance status) mediating 19% of this disparity and tumor biological characteristics (including genomic recurrence scores) mediating 20%. When all factors were combined in a fully adjusted model, 44% of the racial survival disparity was explained, suggesting that social determinants and aggressive tumor biology contribute roughly equally to worse outcomes in Black women, though over half of the disparity remains unexplained. Notably, neighborhood disadvantage itself mediated 8% of racial differences in high-risk recurrence scores, indicating that social factors may influence tumor biology, and highlighting that addressing breast cancer disparities requires dual approaches targeting both structural barriers to healthcare access and quality while investigating the biological mechanisms—including ancestry-related genetic variants and molecular pathways—that may drive more aggressive disease in Black women.
2023
Front Oncol
A study of 80 Black and White women with breast cancer at Emory University Hospitals (2008-2017) examined associations between contemporary neighborhood redlining—a structural racism measure derived from Home Mortgage Disclosure Act data—and DNA methylation patterns in breast tumor tissue. Contemporary redlining was significantly associated with aberrant methylation at 5 CpG sites (FDR<0.10) in genes implicated in breast carcinogenesis, inflammation, immune function, and stress response (ANGPT1, PRG4), with additional top sites showing interaction by ER status and association with mortality; redlining was also associated with epigenetic age acceleration (β=5.35; 95% CI: 0.30-10.4 by Hannum metric). These novel findings suggest that structural racism—manifested through discriminatory housing policies leading to inequitable social and environmental exposures—may biologically embed in the breast tumor epigenome through altered DNA methylation patterns, potentially contributing to documented racial disparities in breast cancer outcomes and highlighting the need for further research on epigenetic mechanisms linking neighborhood-level structural racism to cancer prognosis.
2022
Endocrinology
A review examining PFAS (found in nonstick cookware, food packaging, and stain-resistant fabrics) and parabens (used in personal care products) found that exposure to these endocrine-disrupting chemicals is linked to breast cancer development, with marginalized and socially disadvantaged communities facing disproportionately higher exposures due to structural racism and inequitable environmental conditions. These disparities in chemical exposure may contribute to poorer breast cancer outcomes in these populations, yet breast cancer research continues to underrepresent these communities, limiting our ability to address treatment disparities and improve survival rates. The authors emphasize the urgent need to both reduce EDC exposures in vulnerable communities and increase research inclusion of diverse populations to understand how environmental injustices intersect with breast cancer risk and develop interventions that address these health inequities.