Exploring the Impact of Discrimination on Inflammation in Black Breast Cancer Survivors With Chi-Chen Hong, PhD

The Women’s Circle of Health Follow-Up Study

Dr. Hong’s research draws on the Women’s Circle of Health follow-up study, a cohort of approximately 2,000 Black breast cancer survivors. This collaborative effort, co-led by Dr. Elisa Bandera, MD, PhD, a Professor of Epidemiology at Rutgers Cancer Institute, Dr. Kitaw Demissie, MD, PhD, Dean and Professor of the School of Health at SUNY Downstate, and Dr. Hong, builds on earlier case-control studies to identify factors contributing to more severe disease in Black women.

A recent analysis, presented as a poster at the American Association of Cancer Research (AACR) Annual Meeting, focused on whether self-reported experiences of discrimination were associated with inflammatory biomarkers. The study involved 156 women who provided blood samples two to three years post-diagnosis and completed a validated questionnaire about discrimination in nine settings, including work, school, and medical care.

Investigating Inflammatory Biomarkers

The research team measured four key biomarkers associated with systemic inflammation: high-sensitivity C-reactive protein (CRP), interleukin-6 (IL-6), tumor necrosis factor alpha (TNF-α), and interleukin-1 beta (IL-1β). Dr. Hong explains, “All of these are inflammatory markers, and they potentially can reflect the body’s response to stress or other diseases, infections, and so forth.”

While 74 participants reported experiencing discrimination, the study did not find a statistically significant association between discrimination and biomarker levels after adjusting for confounders. However, Dr. Hong notes, “We did find this not-significant elevation in TNF-α and IL-1β among those individuals that reported experiencing discrimination.” She emphasizes that, despite the small sample size, the findings “suggest a potential link between discrimination, mediated stress, and inflammation in Black breast cancer survivors,” highlighting the need for larger studies.

The Biological Toll of Discrimination

Dr. Hong elaborates on the role of inflammation in cancer outcomes: “Inflammation: it’s a natural protective response, but it could also be higher because of long-term stress.” Chronic inflammation, she explains, is linked to poor outcomes in cancer patients, including increased risk of recurrence and chronic comorbidities such as cardiovascular disease, which is the second most common cause of death among breast cancer patients.

She hypothesizes that discrimination acts as a chronic stressor, keeping the body in a prolonged state of “fight or flight.” This can lead to chronic inflammation and immune suppression, making the body more vulnerable to illness and potentially worsening cancer prognosis. Dr. Hong references the concept of allostatic load, the cumulative physiological wear and tear from chronic stress, as a possible mechanism behind disparities in breast cancer outcomes.

Clinical Implications: The Role of Oncology Professionals

Dr. Hong urges clinicians to recognize the impact of discrimination on health. “It’s really important to listen to patients’ experiences, treat everyone with respect, and be aware that discrimination can potentially affect health.” She advocates for training healthcare providers to promote respect for patients from diverse backgrounds, improve communication, and build trust.

Equitable access to cancer care and support services is also critical. “Addressing discrimination in healthcare means both treating people fairly and pushing for changes in the system to promote equity,” Dr. Hong asserts, suggesting that such efforts could have a long-term positive impact on outcomes for Black patients and other minoritized populations.

Expanding Research and Addressing Social Determinants

Recognizing the limitations of the pilot study, Dr. Hong and her colleagues plan to pursue larger studies with greater statistical power. They are also interested in exploring these questions in other marginalized groups, such as Hispanic women, to understand how unique stressors contribute to health disparities.

Dr. Hong highlights the importance of integrating individual-level risk factors with broader environmental and social determinants of health. “There’s a lot of interest right now in trying to integrate both the individual level risk factors with the sort of broader risk factors, whether environment or social policy or so forth, that also contribute to how well you do.”

Key Takeaways for Oncology Professionals

• Discrimination may act as a chronic stressor, potentially leading to increased inflammation and poorer outcomes in Black breast cancer survivors
• While the pilot study did not find statistically significant associations, trends suggest a possible biological link that warrants further investigation
• Clinicians should be attentive to the experiences of discrimination among their patients, promote respectful care, and advocate for systemic changes to ensure equity
• Future research should include larger, more diverse populations and consider both individual and social determinants of health

Prioritizing Patient Voices and Health Equity

Dr. Hong concludes with a message for both patients and professionals: “The stress potentially caused by discrimination may have these biological effects. They could influence recovery and long-term health. I think just a lot more research is needed in this area to really understand these connections.” She encourages women to “prioritize their health and speak up about their needs, seek support, and know that their experiences matter in both research and care.”

About Dr. Hong

Chi-Chen Hong, PhD, is an Epidemiologist and Associate Professor of Oncology in the Department of Cancer Prevention and Control at Roswell Park Comprehensive Cancer Center specializing in breast cancer research and survivorship. Her work focuses on the impact of lifestyle factors, particularly in Black women, and physiologic pathways, including inflammation, associated with cancer outcomes. Dr. Hong’s research aims to address health disparities and improve the well-being of cancer survivors.