Posted on January 21, 2021

By Heather Sarantis, Environmental Health Consultant to Breast Cancer Action and Guest Writer

I have worked on breast cancer prevention for more than 15 years. Most recently, I co-authored Paths to Prevention: The California Breast Cancer Primary Prevention Plan, a nearly 400-page overview of breast cancer risk factors and potential interventions to reduce those risks. While writing Paths to Prevention, I would often hear people – both researchers and community members – say they wanted to learn more about the connection between breast cancer risk, stress from racism and childhood trauma. Many people think there may be a link, but this field of research is new enough that there is still much to be learned.

I started working with Breast Cancer Action this past summer on a few initiatives and was excited to learn about a 3-year-old research partnership between BCAction (as the community principal investigator) and Child Health and Development Studies (CHDS) (as the researcher principal investigator). The project, called Linking Neighborhood and Individual Adverse Childhood Experiences (ACEs) to Breast Cancer, is a unique study that explores some of the questions that I have heard before. Questions like can where you live affect your breast cancer risk? If so, how? Is there something about living in a racially segregated neighborhood that contributes to breast cancer? What about more aggressive forms of breast cancer? And are these experiences a form of childhood trauma?

This study has a specific focus on Black women, who historically had lower breast cancer rates than white women. In recent years their breast cancer incidence rate has increased and is now similar to white women.[1] Black women, however, are more likely to be diagnosed with more aggressive types of breast cancer and breast cancer that is less responsive to treatment,[2] which may contribute to their mortality rates being 40% higher than for white women.[3] Can any of this be linked to where they lived growing up?

This collaborative study uses the very unique data set of CHDS to try to answer these questions. The original CHDS study started in 1959 with more than 15,000 pregnant women who were members of Kaiser Foundation Health Plan in Oakland, CA. These women filled out extensive questionnaires and gave a sample of blood. Since then, the study has tracked them, their daughters and their granddaughters, collecting new data along the way. This multi-generational data set allows us to explore questions that most researchers can’t begin to touch, making the Linking Neighborhood and Individual Adverse Childhood Experiences to Breast Cancer study possible.

Right now, the research team is in the early stages of working to cross-reference information about where people grew up with data on neighborhood racial segregation, income and education levels, study participants’ race, whether they have been diagnosed with breast cancer, age of diagnosis (if relevant), age of menarche (when girls start their menstrual periods) and breast density (the last two with known relationships to breast cancer risk).

By doing this very extensive and complex analysis, we hope to contribute to the growing field of research about ACEs, which the Centers for Disease Control and Prevention (CDC) defines as “potentially traumatic events that occur in childhood.”[4]  In 1995, the CDC and their partner, Kaiser Permanente launched the revolutionary new field of ACEs research. Early studies explored ways that children who faced adversity such as physical and emotional abuse or neglect at home were at higher lifelong risk for a range of problems including cancer, as well as heart disease, diabetes, obesity, depression, substance abuse, and early death.[5]

As the field of ACEs research grew, new understanding was gained on how chronic, toxic stress in childhood can affect a person over the course of their life. It also grew to recognize that ACEs happen not just at the individual or family level, but also at the community level, for example from community violence or systemic racism.[6]  Multiracial and Black children experience the highest rate of ACEs in the US.[7] [8]

Previous research by CHDS found that the trauma of having one or both parents die does impact breast density, risk for breast cancer, and risk for especially aggressive types of breast cancer.[9] Our current study will help us deepen this understanding by exploring whether the adversity of systemic racism that shapes inequities and injustices in neighborhoods also does. BCAction and CHDS are trying to shine new light on whether the adversity of living in communities heavily burdened by segregation and toxic exposures contributes to biological changes in age of menarche and breast density, and ultimately, in breast cancer diagnosis. If so, we may gain insight into whether it also contributes to the aggressive forms of breast cancer so many Black women suffer from.

Breast Cancer Action is proud to be a partner in this study. When the results are in, we will share what we have learned with the public and explore what the findings might point toward for advocacy and policy change to build a more equitable society.

To learn more about the study and ACEs, listen to our podcast episode with Dr. Barbara Cohn, the lead research principal investigator.

[1] Richardson LC, Henley SJ, Miller JW, Massetti G, Thomas CC. Patterns and Trends in Age-Specific Black-White Differences in Breast Cancer Incidence and Mortality – United States, 1999–2014. MMWR Morb Mortal Wkly Rep 2016;65:1093–1098. DOI: icon.


[3] Richardson LC, Henley SJ, Miller JW, Massetti G, Thomas CC. Patterns and Trends in Age-Specific Black-White Differences in Breast Cancer Incidence and Mortality – United States, 1999–2014. MMWR Morb Mortal Wkly Rep 2016;65:1093–1098. DOI: icon.






[9] From a poster presented at the American Public Health Association 2017 conference: Parental loss in childhood and daughter’s breast cancer in the Child Health and Development Studies (CHDS) Piera M. Cirillo1, Nickilou Y. Krigbaum, Barbara A. Cohn. Child Health and Development Studies, Public Health Institute, Berkeley California.