Exploring Cumulative Disadvantage, Telomere Length, and Breast Cancer Among Black and White Women

Abstract

Objectives: Cumulative disadvantage (CD) is a concept that recognizes the influence of social determinants on health over the lifecourse—emphasizing accumulated stressors as contributors to physiological damage. The shortening of telomeres has been found to have a direct relationship with increased cancer incidence and overall health. The purpose of this research is to develop a triangulated and biologically validated CD instrument to explore breast cancer disparities among Black and White women. Methods: We recruited a purposeful sample of 15 White and 15 Black pre-menopausal women (ages 25–50 years) who had donated normal tissue to the Susan G. Komen Tissue Bank. Semi-structured qualitative interviews, designed to investigate participants’ exposure to lifetime stressors, were conducted. Drawing from the qualitative interviews and previous research, a quantitative survey instrument was developed to capture the range of stressors experienced by our sample of women. All respondents completed the quantitative survey and their telomere length was assessed using DNA extracted from peripheral blood leukocytes. Results: Qualitative and quantitative assessments of CD were consistent across childhood, adult, and lifetime stressors. Black respondents reported more childhood stressors (t=-2.28, p=0.03), adult stressors (t=-1.87, p=0.07), and lifetime stressors (t=-2.17, p=0.04); however, there were no significant differences in subjective assessments of the perceived impact of stress on health. There was some evidence of shortened telomere length among Black respondents with more CD. Discussion: Preliminary analyses provide evidence of triangulation. Future research will further explore associations between CD and telomere length among a larger sample (N=100) of Black and White American women.