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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
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.
2025
Environ Pollut
A study of 574 breast cancer cases and 2,295 controls from rural Arkansas found that moderate exposure to polycyclic aromatic hydrocarbons (PAHs) and high chromium exposure were associated with statistically significant 32% increased breast cancer risk, with the strongest effects observed among women with a family history of breast cancer. When examining 12 hazardous air pollutants as a mixture, there was a suggested but non-statistically significant 21% increased breast cancer risk, with chromium, propylene dichloride, and PCBs contributing most to the elevated risk. This study is important because it demonstrates that hazardous air pollutants pose breast cancer risks even in rural areas, which are often overlooked in environmental health research despite experiencing different pollution sources and healthcare disparities compared to urban populations.
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.
2022
Environ Res
This case-only study included 2,998 women with breast cancer from the Women’s Circle of Health Study and examined how characteristics of hair dye and hair relaxer use were related to tumor features. Compared with women who only used salon-applied permanent hair dye, those using home dye kits or both salon and home dye had higher odds of having poorly differentiated (more aggressive) tumors, especially among Black women (for Black women: home kits OR 2.22, 95% CI: 1.21–5.00; combination use OR 2.46, 95% CI: 1.21–5.00) and among women with ER-positive tumors (combination use OR 2.98, 95% CI: 1.62–5.49). Combination use of hair relaxers was also associated with larger tumors (>2.0 cm vs <1.0 cm; OR 1.82, 95% CI: 1.23–2.69). Although some associations did not remain statistically significant after strict multiple-comparison correction, the overall pattern suggests that frequent, mixed use of hair dyes and relaxers may be linked to more aggressive breast tumor characteristics.
2022
Cancer Epiemiol
The first Indian case-control study examining phthalates (chemicals widely used in plastics, cosmetics, and food packaging) and breast cancer found that women with higher urinary levels of di-butyl phthalate (DBP) had 1.5 times increased breast cancer risk, while those with higher DEHP levels had nearly 3 times increased risk. Analysis of breast tumor tissue revealed mutations in several genes known to respond to phthalate exposure, affecting pathways involved in hormones, metabolism, and cancer development. These findings suggest that exposure to certain phthalates may increase breast cancer risk through genetic changes, though larger studies are needed to confirm these results and understand how early-life exposures might contribute to cancer development later in life.
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
Maturitas
A comprehensive review of breast cancer disparities highlights that Non-Hispanic Black women experience markedly elevated breast cancer mortality due to multifactorial causes, including unique risk profiles such as higher prevalence of early-onset triple-negative breast cancer, specific reproductive risk factors, obesity patterns traced to infant feeding practices, and barriers to genetic risk assessment and high-risk referrals. The authors propose risk- and race-based screening strategies given the prevalence of aggressive early-onset disease in young Black women, emphasize the importance of early hereditary/familial risk identification while addressing challenges in interpreting uncertain genetic results, and stress the need for culturally sensitive approaches to healthy lifestyle promotion and clinical trial participation. Addressing breast cancer disparities requires tackling social determinants of health, educating patients and clinicians about factors driving outcome inequities, building trust to foster adherence and follow-up, and encouraging participation in targeted research to better serve all communities and reduce the disproportionate burden of breast cancer mortality in Black women.
2024
CA Cancer J Clin
Every two years, the ACS releases a report of updates on statistics on breast cancer among women. One in eight U.S. women will be diagnosed with invasive breast cancer, a 13% lifetime risk. From 2012 to 2021, diagnoses rose by 1% annually, with a 1.4% increase for women under 50. Asian American and Pacific Islander (AAPI) women saw the fastest rise in diagnoses. Despite a 44% drop in mortality since 1989, disparities persist—mortality rates remain highest among Black women, and there’s been no improvement for American Indian/Alaska Native women. These findings highlight the urgent need for equitable breast cancer diagnosis and treatment.
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
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
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.
2024
Environ Sci Technol
A study of 751 reproductive-aged Black women found that the relationship between personal care product (PCP) use and exposure to endocrine-disrupting chemicals (EDCs) varied significantly by socioeconomic status (SES), with different patterns of chemical exposure from the same products depending on women’s education, income, and employment. For example, vaginal powder use was associated with higher phenol exposure (a class of EDCs) among lower SES women but showed no such association in higher SES women, suggesting that product formulations, brands, or usage patterns may differ across SES groups. These findings highlight that Black women face inequitable EDC exposures that are influenced by both race and socioeconomic factors, underscoring the need for targeted public health interventions that address these intersecting disparities in chemical exposures from everyday products
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.
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
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
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.
2023
Endocrinol Metab Clin North Am
Multiple social and structural determinants of health undoubtedly contribute to the marked racial/ethnic-, gender-, and socioeconomic-based disparities in endocrine health; however, the contribution of environmental injustice is vastly underappreciated. Indeed, those groups disproportionately burdened by endocrine disorders are often exposed to higher levels of various EDCs, including PCBs, phthalates, bisphenols, OC pesticides, air pollutants, PFASs, toxic metals/metalloids, and BFRs. These chemicals threaten our reproductive and metabolic health, contributing to diabetes prevalences, obesity, and disorders related to hormonal regulation. This review increases awareness of these disparities and encouraged equitable healthcare for those who are disadvantaged.
2023
Breast Cancer Res Treat
A study of 1,398 Black women (567 breast cancer cases, 831 controls) found preliminary evidence of gene-environment interactions between genetic variants in the mTOR signaling pathway and vigorous physical activity affecting breast cancer risk, though results did not survive correction for multiple testing. Specific variants in AKT1 were associated with 49-85% reduced ER-positive breast cancer risk only among physically active women, while an MTOR variant showed a 124% increased ER-positive cancer risk and an EIF4E variant showed dramatically elevated ER-negative cancer risk (over 20-fold), but only in the context of vigorous physical activity. These exploratory findings suggest that the relationship between physical activity and breast cancer may vary by genetic background in Black women, potentially explaining some of the heterogeneity in physical activity-breast cancer associations, though larger studies with multiple testing correction are needed to confirm whether these gene-exercise interactions truly modify breast cancer risk.
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.
2021
Sci Rep
A combined analysis of five Finnish cohorts including 6,374 postmenopausal women examined whether adherence to three dietary quality indices—the modified Nordic Diet (mNDI), modified Mediterranean diet (mMEDI), and modified Alternative Healthy Eating Index (mAHEI)—was associated with breast cancer risk over an average 10-year follow-up during which 274 breast cancer cases were diagnosed. The study found a borderline protective association for the highest versus lowest adherence to the Nordic Diet (HR = 0.67; 95% CI 0.48-1.01), but no significant associations for the Mediterranean diet (HR = 0.88) or Alternative Healthy Eating Index (HR = 0.89). The authors note that the Nordic Diet, which is more aligned with local Finnish food culture, showed the strongest protective trend, though the association did not reach statistical significance. These findings suggest that while healthy dietary patterns have been linked to prevention of various chronic diseases, their relationship with postmenopausal breast cancer risk is not clearly established, with limited evidence for dietary factors beyond alcohol consumption affecting breast cancer risk.
2019
J Occup Environ Med
This case control study was conducted among Hispanic women agricultural workers who are exposed to pesticides. Chemicals associated with BC risk included organophosphates, organochlorines, and a phthalimide, Captan. The study concluded that agricultural work may be associated with increased BC risk in female Hispanic farm workers.
2019
Breast Cancer Res Treat
A systematic review and meta-analysis of 11 cohort studies found that a history of stressful life events was associated with an 11% increased risk of breast cancer (pooled risk ratio: 1.11, 95% CI: 1.03-1.19). While the increase is modest, the finding suggests that psychological stress may play a role in breast cancer development and that women who experience significant life stressors could benefit from psychological and counseling services as a potential preventive measure. These results add to growing evidence linking chronic stress exposure to cancer risk and underscore the importance of addressing mental health and stress management as part of comprehensive breast cancer prevention strategies.
2018
Breast Cancer Res Treat
A meta-analysis of 25 epidemiological studies (23 cohort studies and 2 randomized trials) found that hormone replacement therapy (HRT) was associated with a 33% increased breast cancer risk overall, with combined estrogen-progestin therapy (EPT) showing stronger associations than estrogen-only therapy (ET). EPT was associated with both ductal (51% increased risk) and lobular breast cancer (38% increased risk), and all HRT types were linked to ER-positive but not ER-negative breast cancers, consistent with hormone-driven carcinogenesis. Notably, Asian women using HRT showed higher breast cancer risk than Western women, possibly due to differences in baseline hormone levels, genetic susceptibility, body composition, or HRT formulations used—a finding highlighting the importance of considering racial and ethnic differences when counseling women about menopausal hormone therapy risks and benefits.
2018
Eur J Public Health
A 34-year study in Italy’s Veneto Region, where drinking water was contaminated with PFAS chemicals from a manufacturing plant operating since 1964, found significantly higher mortality rates in contaminated communities compared to uncontaminated areas for multiple diseases including diabetes, heart disease, stroke, Alzheimer’s, and breast cancer in women. Women in PFAS-contaminated areas showed elevated mortality from kidney cancer, breast cancer, and Parkinson’s disease, while both men and women had increased deaths from cardiovascular and metabolic diseases. These population-level findings suggest PFAS exposure—from widespread “forever chemicals” used in nonstick cookware, food packaging, stain-resistant fabrics, and firefighting foam—may increase risks for multiple serious diseases including breast cancer, though individual-level studies are needed to confirm causal relationships and understand the mechanisms behind these health impacts.
2018
Breast Cancer Res
A pooled analysis of three population-based case-control studies including 6,320 women (3,934 cases, 2,386 controls) aged 35-64 years examined whether the associations between body mass index (BMI) and breast cancer risk differ by tumor subtype defined by estrogen receptor (ER), progesterone receptor (PR), and HER2 status. Higher BMI at age 18 was inversely associated with premenopausal breast cancer risk across all ER/PR/HER2 subtypes (≥25 vs. <20 kg/m²: OR=0.72), with the strongest protection seen in premenopausal women who had high BMI both at age 18 and currently (46% reduced risk; OR=0.54; 95% CI: 0.38-0.78), while no significant associations were found for postmenopausal breast cancer. The findings indicate that high BMI during late adolescence provides similar protective effects against all molecular subtypes of premenopausal breast cancer regardless of hormone receptor or HER2 status, and this protection appears to be maximized when women maintain higher BMI consistently throughout their premenopausal years. These results suggest that the mechanisms by which adiposity protects against premenopausal breast cancer operate broadly across different tumor subtypes rather than being specific to hormone receptor-positive disease.
2016
Cancer Med
A review examining breast cancer disparities in African American women—who now have similar incidence rates to non-Hispanic White women but significantly higher mortality—found growing evidence linking hair product use to breast cancer risk through exposure to estrogen-like chemicals and endocrine-disrupting chemicals (EDCs). The review identified three converging lines of evidence: environmental estrogen and EDC exposures increase breast cancer risk, these chemicals are present in personal care products including hair products, and certain hair products used disproportionately by African American women may contribute to elevated breast cancer risk in this population. The findings highlight an understudied environmental justice issue and call for additional research using community-collaborative approaches to better understand how culturally specific beauty practices may contribute to health disparities, representing what researchers term the potential “cost of beauty.”