How socioeconomic factors affect outcomes in this deadly cancer
· Medical Xpressedited by Swati Mestri, reviewed by Robert Egan
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Black women diagnosed with hormone receptor–positive (HR+) breast cancer experience significantly worse outcomes than white women.
With HR+ breast cancer representing the most common type of breast cancer and a leading cause of cancer-related death in women around the world, Svasti Haricharan's lab set out to uncover more about why this gap exists and how it can be closed.
The findings are published in the journal Cancer Research.
Looking beyond ancestry
Research has shown that genetics plays a large role in health disparities for a range of diseases and conditions. With this hypothesis in mind, Haricharan and her team searched for a data set to examine the specific race- or ancestry-based molecular biology that may lead to poorer HR+ breast cancer outcomes in Black women.
"Most existing data sets heavily underrepresent anyone who is nonwhite, so we went to the Department of Veterans Affairs, which has the largest archival tissue bank from nonwhite women," Haricharan said.
When her team took a close look at the HR+ breast cancer cells in Black and white women, the results were not what they were expecting.
"What stood out immediately was that we weren't seeing that many differences in what was happening inside the cancer cells, but we were seeing differences in what was happening outside the cells," Haricharan said.
Often, disparities can be explained by differences within the cancer cells, such as genetic mutations that are associated with ancestry. But differences outside the cells, like those the team found, are caused by lifestyle factors.
"The findings didn't actually seem to match with ancestry, but more with lifestyle factors and social determinants," Haricharan said. "It was not necessarily based on how much of a certain ancestry you had, but more the burdens you might face because of that identity, the cultural milieu in which you were growing up or the life challenges you were facing, which are so often in this world associated with structural determinants, because of racism and other structural factors."
Collagen patterns shape cancer spread
The differences mainly appeared in the women's collagen, which is like glue that cells cling to as they grow in tissues throughout the body.
"The collagen architecture was very different in Black women compared to white women," Haricharan said. "If Black women didn't have that collagen patterning, cancer cells could not metastasize. Weirdly, cells from white women didn't have that same requirement. In fact, when we put cells from white women into the same collagen architecture that we see in Black women's breasts, the cells stopped metastasizing."
Similar differences in collagen architecture have been shown for other types of cancer, but her team has now demonstrated them with HR+ breast cancer.
Immune response linked to poverty
Haricharan's team also noticed that the immune response process—which requires immune cells to break through collagen to attack cancer cells—was different in Black and white women.
"Black women's tumors had way more immune cells, but they were not good at killing cancer cells, whereas in white women's tumors, there were far fewer immune cells, but they were really good at killing cancer cells," Haricharan said. "Other studies have shown that ancestry dictates the kind of immune response you can raise, but we found out that actually that immune phenotype was linked to poverty burden and not to race."
Further examination revealed that white women who faced a high poverty burden showed the same issue—many immune cells that were not able to kill cancer cells—proving that the issue is linked to socioeconomic conditions.
"Because Black women in the U.S. and in many parts of the world are more likely to live in high-poverty areas or face high poverty burden, there's been this misunderstanding of the data in the cancer research field," Haricharan said. "We've all thought that this immune phenotype was associated with race and ancestry, but it looks like it is only aligned with poverty burden, maybe because of chronic stress."
Broadening precision oncology beyond white women
Haricharan focused on disparities in HR+ breast cancer because this subtype is often overlooked in the research field, despite being the most common type of breast cancer Black women are diagnosed with. She hopes this study encourages the broader research community to adopt a more holistic view, examining factors outside the cell, and outside the body, that may affect health.
"Right now, precision oncology is largely based on data from white women, which means it is very precise for white women, but it is not very representative for most other demographics of women," Haricharan said. "So, the idea that things like poverty burden can affect patient outcome by directly changing the biology of the cancer cell tells us we need to be taking a wider view of how we study these systems, and suggests a path forward for how we could have a better-educated, more equitable precision oncology system."
Haricharan is now expanding on this study in collaboration with UC San Diego using a sample of 7,000 HR+ breast cancer patients of multiple mixed ancestries to see if they notice the same differences in other nonwhite minority women that they found in Black women.
"Whether you're a scientist or a layperson or a breast cancer survivor, you think of cancer as this unique monster living inside your body," Haricharan said. "But, really, so much of what a cancer cell is is defined by what's around it and what you're going through in your life. A beacon of hope is that now that we can make these data sets that have better annotations for life experience factors, maybe that is the code to make us one step closer to a cure."
Publication details
Jerry T. DeWitt et al., Patient Sociodemographic Factors Impact the Breast Cancer Microenvironment, Cancer Research (2026). DOI: 10.1158/0008-5472.can-25-5500
Journal information: Cancer Research
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OncologyWomen's healthCommon illnesses & Prevention Provided by San Diego State University Who's behind this story?
Swati Mestri
Swati Mestri holds a bachelor's degree in Electronics Engineering and has worked as a content editor since 2019. She has experience editing research documents across technology, health care, and materials science, and has a particular interest in technology and space. Full profile →
Robert Egan
Bachelor's in mathematical biology, Master's in creative writing. Well-traveled with unique perspectives on science and language. Full profile →
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