Ask an Expert: Breast Cancer with Lauren McCullough
By Karina Antenucci
Breast cancer affects women of all races. However, it does not affect them equally. While white women are more likely to get breast cancer, Black women are more likely to die of it in the U.S.
According to the American Cancer Society, 41% more likely, to be exact.
“In some areas, such as Georgia, that difference is even greater,” says Lauren McCullough, PhD, associate professor of epidemiology, whose research group is currently working on 18 active breast cancer-related projects.
In this Ask an Expert, McCullough discusses the factors influencing these disparities, shares eye-opening research findings, and invites you to join the conversation at an upcoming community event.
Your lab’s BRIDGE program combines several areas of research to understand breast cancer outcome disparities. Why is this important?
For a long time, we’ve thought about the contributors to poor breast cancer outcomes, such as the genetic, biologic, health care, or individual-level factors on their own. Our BRIDGE research team, which is made up of Rollins postdocs, doctoral students, and faculty, is centered around understanding how a combination of things work together to influence a person’s risk of being diagnosed with or dying from breast cancer. This is important because we treat people, not exposures or genes. When you take things outside of the full context, the recommendations for treatment or prevention may not be relevant. BRIDGE has really focused on bridging the molecular with the social, the health services research with the epidemiologic. That way, we can make interventions relevant for individuals.
What are the risk factors related to breast cancer for everyone?
Age, family history including genetic mutations, physical activity or inactivity, and obesity are all well-established risk factors. There are also a number of things related to reproduction, including how old women are when they have their first child, how many children they have, how long they breastfed, and more. Other factors like tobacco smoking and certain dietary exposures can increase the risk minimally as well.
Have any surprising findings come out of your recent breast cancer research?
Several of our projects are trying to understand the role of place in whether or not people die of breast cancer. One of the things that we’re finding consistent across several studies is that for white women, neighborhoods matter a lot. Meaning, white women who live in deprived neighborhoods have worse breast cancer outcomes than those who live in better neighborhoods. For Black women, this is not the case. It doesn’t matter if they live in a more affluent neighborhood; they are still having worse outcomes than one would expect. We can then assume that there are factors in treating marginalized, minority women that aren’t accounted for by neighborhood, such as the biases of health care institutions or the day-to-day discrimination that may accelerate tumor growth and treatment response.
Are there any other notable differences in outcomes that you are studying right now?
Another broad focus for our group is understanding the role of comorbidities in breast cancer outcomes. Black women are not only more likely to die of breast cancer, but they are also more likely to be diagnosed with comorbidities like heart disease and diabetes. Eighty percent of Black women who are diagnosed with breast cancer are overweight or obese. So, we’re trying to determine how that plays a role in the effectiveness of breast cancer treatments and survivorship by looking at how neighborhoods and social and structural determinants relate to those chronic conditions. Then, how those chronic conditions impact the breast tumor environment and, ultimately, cancer outcomes.
Are there any major disparities in breast cancer prevention or treatment?
While national data show that screening rates are equal between Black and white women, our research has found that Black women aren’t receiving adequate follow up after their initial abnormal screens, which is likely a driver for them being diagnosed at later stages. Another major disparity is that Black women are being diagnosed with more aggressive tumors that are harder to treat. We have early evidence that living in low-resource neighborhoods (potentially with greater environmental toxicants and everyday stressors) may contribute to aggressive breast cancers.
How will the American Cancer Society VOICES of Black Women project be a gamechanger for Black women and breast cancer?
We are recruiting 100,000 Black women for a study that will be ongoing for 30 years to understand why Black women both get more aggressive forms of breast cancer and die disproportionately. This month, enrollment will open in Georgia and Virginia (voices.cancer.org). In May 2024, we will launch the study across 20 U.S. states and the District of Columbia.
What do you hope to accomplish at the upcoming BRIDGE Community Forum at Rollins?
On October 21 from 10 a.m. to 2 p.m., we are hosting a community event that is intended to bring together stakeholders around breast cancer disparities, specifically in Georgia. The event will feature the latest research in the state, provide opportunities for patients and survivors to engage with providers, and highlight some of the work done by our community partners. Importantly, the forum will feature our breast cancer survivor focus group who will be there to share their experiences working with our research team. Click here to register.
Lauren McCullough’s research program integrates molecular epidemiology, epigenetics, and other biomarkers for disease risk and progression; environmental and social epidemiology; and causal inference methods. Her research goals are to improve cancer outcomes in underserved populations. McCullough’s accolades include receiving the 2023 ASPPH Early Career Research Excellence Award, a national competitive award across all schools and programs of public health.
