Race, Stress, and Breast Cancer: A Scoping Review

Objective Toxic stress may influence breast cancer (BC) risk and progression through various physiological and biological pathways, potentially differing based on racial categories. We systematically reviewed the literature on the relationship between race, stress, and BC. Methods We searched PubMed (prior to August 2023), Embase, Web of Science, PsycINFO, and Scopus (prior November 2023) to identify relevant peer-reviewed studies. Two independent reviewers screened titles, abstracts, and full text, with disagreements resolved by discussion or a third reviewer. Data extraction and thematic synthesis were conducted independently. Results We identified 30 articles, including 21 original observational studies and 9 reviews. Primary studies explored biological markers including measures of allostatic load (AL), epigenetic changes, and social determinants of health. Studies explored biological marker, AL, epigenetic changes, and social determinants of health. Black women with BC exhibited higher AL and shorter telomeres compared to White women. Epigenetic modifications were associated with social determinants, potentially influencing BC risk and aggressiveness. Significant associations were found between neighborhood disadvantage, social support, and psychosocial stress among women of color with BC. Conclusion This review provides a landscape view of the current evidence on the complex interplay between social stressors, biological responses, and racial and ethnic disparities in BC outcomes. Findings highlight the significant role of chronic psychosocial stress in the disproportionate burden of breast cancer faced by marginalized groups. Further research is needed to explore mechanisms and evaluate multilevel interventions addressing individual stress management, neighborhood resources, and societal-level policies to improve breast cancer prevention, detection, and management.