USC researchers examine social and clinical drivers of stress responses among African American breast cancer survivors

While there have been numerous studies examining breast cancer disparities experienced by Black/African American women, there is still a persistent mortality gap among this demographic. In an effort to improve breast cancer diagnosis, treatment, and recovery of Black women, USC researchers are now focused on identifying multilevel drivers that contribute to increased risk and poor outcomes. In a first-of-its-kind cross-sectional study published in a Nature journal, the research team decided to investigate whether the key to understanding these inequities is rooted in the social context of the cancer care continuum. They measured cortisol levels among Black cancer patients to better understand the relationship between stress responses and women breast cancer survivors’ lived experiences with cancer health outcomes.

“We were interested in really looking at whether there are any social or clinical drivers of the stress response among Black women who are breast cancer survivors,” says lead author Fatimata Sanogo, PhD, a senior research scientist in the Department of Population and Public Health Sciences at the Keck School of Medicine of USC. This is in line with an emerging hypothesis that one’s lived experience and physiological response to social stressors may influence biological processes involved in the disease’s initiation and progression. “There is substantial data that looks at the big picture such as the neighborhood level or socioeconomic status as determinants of health, but we want to look at the individual level because disparities are more than just about where you live – it’s also how you live,” she affirms.

Currently, data on stress hormones and social risk factors have been limited. Yet, cortisol plays a significant role in inflammatory responses, metabolism, and overall immune functioning. According to Sanogo’s study, until now little was known about “cortisol levels among Black women who have a personal history of breast cancer, even though these women are likely to have great exposure to adverse social conditions that are associated with poorer survival.” The study characterized social stressors around life events asking participants about stressors related to their health, work, financial status, and crime/legal matters.

The study revealed that patients with hypertension and those who experienced more negative life events were significantly more likely to have elevated cortisol levels. These negative effects reflected the cumulation of adverse effects of social stressors. “Our findings suggest the overall negative life experiences, rather than individual markers such as socioeconomic indicators of adversity are associated with stress response markers,” she says.

“A deeper understanding of the lived experience of Black women is required to improve the precision of prevention, early detection, and treatment of breast cancer to address cancer health equity,” says Chanita Hughes Halbert, PhD, senior author on the paper. The authors also recommend screening patients for social determinants of health to identify the needs and stressors of this population. “This could help with implementing stress reduction interventions such as mind-body practices which are beneficial to patients who experience other chronic conditions,” Sanogo shares. She also believes that further research is needed to better understand the downstream effects of high cortisol levels among Black cancer survivors. In the future, she hopes to replicate these types of studies in a bigger population with a racially diverse sample to understand the stress response system among all women cancer patients.