\u3cem\u3eMy Crown and Glory\u3c/em\u3e: Community, Identity, Culture, and Black Women’s Concerns of Hair Product-Related Breast Cancer Risk

Breast cancer (BC) incidence rates for Black and non-Hispanic White women have recently converged; however, Black women continue to die at higher rates from the disease. Black women also use hair products containing hormonally active chemicals at higher rates than other races and ethnic groups. Studies now link chemical components in hair and personal care products to breast cancer risk. Using a community-based participatory research approach, this qualitative study explored community concerns about the role of hair products on breast cancer risk. Focus groups and key informant interviews using triangulation to assure relevant perspectives (women with and without breast cancer as well as younger and older women of differing SES, stylists) explored women’s perceived risk and knowledge of breast cancer risk factors. Data analysis used grounded theory methods of coding facilitated by QDA-Miner. Findings from 91 participants indicated varying levels of awareness but near universal concerns about the potential link of hair products to BC. Breast cancer is a significant concern for Black women and their loved ones. While women were concerned and some respondents believed ingredients in hair products may be harmful to their health, they wrestled with the idea of making changes as hair for most is aligned with beauty, individuality, and identity. For many altering their product use patterns to potentially less risky choices pits health against identity. Health education interventions to minimize harmful hair product usage must acknowledge and incorporate cultural normative beliefs of hair for Black women

Social determinants of health and lung cancer surgery: a qualitative study

IntroductionSocial determinants of health (SDOH) are non-clinical factors that may affect the outcomes of cancer patients. The purpose of this study was to describe the influence of SDOH factors on quality of life (QOL)-related outcomes for lung cancer surgery patients.MethodsThirteen patients enrolled in a randomized trial of a dyadic self-management intervention were invited and agreed to participate in semi-structured key informant interviews at study completion (3 months post-discharge). A conventional content analysis approach was used to identify codes and themes that were derived from the interviews. Independent investigators coded the qualitative data, which were subsequently confirmed by a second group of independent investigators. Themes were finalized, and discrepancies were reviewed and resolved.ResultsSix themes, each with several subthemes, emerged. Overall, most participants were knowledgeable about the concept of SDOH and perceived that provider awareness of SDOH information was important for the delivery of comprehensive care in surgery. Some participants described financial challenges during treatment that were exacerbated by their cancer diagnosis and resulted in stress and poor QOL. The perceived impact of education varied and included its importance in navigating the healthcare system, decision-making on health behaviors, and more economic mobility opportunities. Some participants experienced barriers to accessing healthcare due to insurance coverage, travel burden, and the fear of losing quality insurance coverage due to retirement. Neighborhood and built environment factors such as safety, air quality, access to green space, and other environmental factors were perceived as important to QOL. Social support through families/friends and spiritual/religious communities was perceived as important to postoperative recovery.DiscussionAmong lung cancer surgery patients, SDOH factors can impact QOL and the patient’s survivorship journey. Importantly, SDOH should be assessed routinely to identify patients with unmet needs across the five domains. SDOH-driven interventions are needed to address these unmet needs and to improve the QOL and quality of care for lung cancer surgery patients

Parabens Promote Protumorigenic Effects in Luminal Breast Cancer Cell Lines With Diverse Genetic Ancestry

Context One in 8 women will develop breast cancer in their lifetime. Yet, the burden of disease is greater in Black women. Black women have a 40% higher mortality rate than White women, and a higher incidence of breast cancer at age 40 and younger. While the underlying cause of this disparity is multifactorial, exposure to endocrine disrupting chemicals (EDCs) in hair and other personal care products has been associated with an increased risk of breast cancer. Parabens are known EDCs that are commonly used as preservatives in hair and other personal care products, and Black women are disproportionately exposed to products containing parabens. Objective Studies have shown that parabens impact breast cancer cell proliferation, death, migration/invasion, and metabolism, as well as gene expression in vitro. However, these studies were conducted using cell lines of European ancestry; to date, no studies have utilized breast cancer cell lines of West African ancestry to examine the effects of parabens on breast cancer progression. Like breast cancer cell lines with European ancestry, we hypothesize that parabens promote protumorigenic effects in breast cancer cell lines of West African ancestry. Methods Luminal breast cancer cell lines with West African ancestry (HCC1500) and European ancestry (MCF-7) were treated with biologically relevant doses of methylparaben, propylparaben, and butylparaben. Results Following treatment, estrogen receptor target gene expression and cell viability were examined. We observed altered estrogen receptor target gene expression and cell viability that was paraben and cell line specific. Conclusion This study provides greater insight into the tumorigenic role of parabens in the progression of breast cancer in Black women

The Impact of the COVID-19 Pandemic on Care Delivery and Quality of Life in Lung Cancer Surgery

Background The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (COVID-19) pandemic and associated restrictions have altered the delivery of surgical care. The purpose of this study was to explore the impact of COVID-19 on care delivery and quality of life (QOL) from the perspectives of lung cancer surgery patients, family caregivers (FCGs), and thoracic surgery teams. Methods Patients/FCGs enrolled in a randomized trial of a self-management intervention for lung cancer surgery preparation/recovery were invited to participate in this qualitative study. Patients/FCGs data were collected separately 1-month postdischarge. Interviews were also conducted with thoracic surgery team members. Content analysis approaches were used to develop themes. Results Forty-one respondents including 19 patients, 18 FCGs, three thoracic surgeons, and one nurse practitioner participated in the study. Patient themes included isolation, psychological distress, delayed/impacted care, and financial impact. FCGs themes included caregiving challenges, worry about COVID-19, financial hardship, isolation, and physical activity limitations. Surgical team themes included witnessing patient/FCG\u27s distress, challenges with telehealth, communication/educational challenges, and delays in treatment. Conclusions COVID-19 had a varied impact on care delivery and QOL for lung cancer surgery dyads. Some dyads reported minimal impact, while others experienced added psychological distress, isolation, and caregiving challenges. Surgical teams also experienced challenges in the approach used to provide care

\u3cem\u3eHeavy is the Head that Wears the Crown\u3c/em\u3e: Black Men’s Perspective on Harmful Effects of Hair Product Use and Breast Cancer Risk

Racial disparities in breast cancer are well-documented, and Black women assume a disproportionate burden of breast cancer mortality. Black women also commonly use hair products containing endocrine disrupting chemicals (EDCs) more often at an increased rate, as compared to other racial/ethnic groups. Emerging findings have reported the use of hair and other personal care products containing EDCs may contribute to breast cancer risk. While some sociocultural perspectives about hair and identity have been explored, the role of beauty expectations upheld by males has not been studied. Through a community-based participatory methodology, we explored perceptions and beliefs held by Black men regarding Black women’s hair, chemical exposures in hair products, and breast cancer risk. Focus groups and key informant interviews—among men with and without partners with a history of breast cancer—were used to examine the male perspective regarding the attractiveness of Black hairstyles, opinions of beauty norms, and knowledge of breast cancer risk factors. Interviews were audio-recorded, transcribed, and analyzed guided by grounded theory methods. From the 66 participants interviewed, there was general support for natural hairstyles, which were associated with confidence and self-esteem in women. Men agreed that beauty standards and societal pressures play notable roles in the women’s personal behaviors though they mostly lacked knowledge of women’s breast cancer risk related to EDCs found in personal care products. Participants suggested a multipronged strategy centered on community education involving social and traditional media campaigns, and the engagement of policy makers in intervention efforts

Social Determinants of Health Among Family Caregiver Centered Outcomes in Lung Cancer: A Systematic Review

Background: Lung cancer is the leading cause of cancer death globally. Both lung cancer patients and family caregivers (FCGs) have unmet quality of life (QOL) needs. An understudied topic in lung cancer research is the role of social determinants of health (SDOH) on QOL outcomes for this population. The purpose of this review was to explore the state of research on SDOH FCGs centered outcomes in lung cancer. Methods: The databases PubMed/MEDLINE, Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, and American Psychological Association (APA) PsycInfo were searched for peer-reviewed manuscripts evaluating defined SDOH domains on FCGs published within the last ten years. The information extracted using Covidence included patients, FCGs and study characteristics. Level of evidence and quality of articles were assessed using the Johns Hopkins Nursing Evidence-Based Practice Rating Scale. Results: Of the 344 full-text articles assessed, 19 were included in this review. The social and community context domain focused on caregiving stressors and interventions to reduce its effects. The health care access and quality domain showed barriers and underuse of psychosocial resources. The economic stability domain indicated marked economic burdens for FCGs. Four interconnected themes emerged among articles on the influence of SDOH on FCG-centered outcomes in lung cancer: (I) psychological well-being, (II) overall quality of life, (III) relationship quality, and (IV) economic hardship. Notably, most participants in the studies were White females. The tools used to measure SDOH factors included primarily demographic variables. Conclusions: Current studies provide evidence on the role of SDOH factors on lung cancer FCGs’ QOL. Expanded utilization of validated SDOH measures in future studies would provide greater consistency in data, that could in turn inform interventions to improve QOL. Further research focusing on the domains of education quality and access and neighborhood and built environment should be carried out to bridge gaps in knowledge

Genetic Ancestry, Skin Color and Social Attainment: The Four Cities Study

Introduction The Black population in the US is heterogeneous but is often treated as monolithic in research, with skin pigmentation being the primary indicator of racial classification. Objective: This paper examines the differences among Blacks by comparing genetic ancestry, skin color and social attainment of 259 residents across four US cities—Norman, Oklahoma; Cincinnati, Ohio; Harlem, New York; and Washington, District of Columbia. Methods Participants were recruited between 2004 and 2006 at community-based forums. Cross-sectional data were analyzed using chi-square tests, correlation analyses and logistic regression. Results There were variations in ancestry, melanin index and social attainment across some cities. Overall, men with darker skin color, and women with lighter skin color were significantly more likely to be married. Darker skin individuals with significantly more West African ancestry reported attainment of graduate degrees, and professional occupations than lighter skin individuals. Conclusions Our findings suggest differences in skin pigmentation by geography and support regional variations in ancestry of US Blacks. Biomedical research should consider genetic ancestry and local historical/social context rather than relying solely on skin pigmentation as a proxy for race

Associations of Hair Dye and Relaxer Use with Breast Tumor Clinicopathologic Features: Findings from the Women’s Circle of Health Study

Background Building upon our earlier findings of significant associations between hair dye and relaxer use with increased breast cancer risk, we evaluated associations of select characteristics of use with breast tumor clinicopathology. Methods Using multivariable-adjusted models we examined the associations of interest in a case-only study of 2998 women with breast cancer, overall and stratified by race and estrogen receptor (ER) status, addressing multiple comparisons using Bonferroni correction. Results Compared to salon application of permanent hair dye, home kit and combination application (both salon and home kit application) were associated with increased odds of poorly differentiated tumors in the overall sample. This association was consistent among Black (home kit: OR 2.22, 95 % CI: 1.21–5.00; combination: OR 2.46, 95 % CI: 1.21–5.00), but not White women, and among ER+ (home kit: OR 1.47, 95 % CI: 0.82–2.63; combination: OR 2.98, 95 % CI: 1.62–5.49) but not ER-cases. Combination application of relaxers was associated with increased odds of tumors \u3e2.0 cm vs. \u3c1.0 cm (OR = 1.82, 95 % CI: 1.23–2.69). Longer duration and earlier use of relaxers and combination application of permanent hair dyes and relaxers were associated with breast tumor features including higher tumor grade and larger tumor size, which often denote more aggressive phenotypes, although the findings did not maintain significance with Bonferroni correction. Conclusions These novel data support reported associations between hair dye and relaxer use with breast cancer, showing for the first time, associations with breast tumor clinicopathologic features. Improved hair product exposure measurement is essential for fully understanding the impact of these environmental exposure with breast cancer and to guide risk reduction strategies in the future

Assessment of Personal Care Product Use and Perceptions of Use in a Sample of US Adults Affiliated with a University in the Northeast

Evidence supports unequal burdens of chemical exposures from personal care products (PCPs) among some groups, namely femme-identifying and racial and ethnic minorities. In this study, we implemented an online questionnaire to assess PCP purchasing and usage behaviors and perceptions of use among a sample of US adults recruited at a Northeastern university. We collected PCP use across seven product categories (hair, beauty, skincare, perfumes/colognes, feminine hygiene, oral care, other), and behaviors, attitudes, and perceptions of use and safety across sociodemographic factors to evaluate relationships between sociodemographic factors and the total number of products used within the prior 24–48 h using multivariable models. We also summarized participants’ perceptions and attitudes. Among 591 adults (20.0% Asian American/Pacific Islander [AAPI], 5.9% Hispanic, 9.6% non-Hispanic Black [NHB], 54.6% non-Hispanic White [NHW], and 9.9% multiracial or other), the average number of PCPs used within the prior 24–48 h was 15.6 ± 7.7. PCP use was greater among females than males (19.0 vs. 7.9, P \u3c 0.01) and varied by race and ethnicity among females. Relative to NHWs, AAPI females used fewer hair products (2.5 vs. 3.1) and more feminine hygiene products (1.5 vs. 1.1), NHB females used more hair products (3.8 vs. 3.1), perfumes (1.0 vs. 0.6), oral care (2.3 vs. 1.9), and feminine hygiene products (1.8 vs. 1.1), and multiracial or other females used more oral care (2.2 vs. 1.9) and feminine hygiene products (1.5 vs. 1.1) (P-values \u3c0.05). Generally, study participants reported moderate concern about exposures and health effects from using PCPs, with few differences by gender, race, and ethnicity. These findings add to the extant literature on PCP use across sociodemographic characteristics. Improving the understanding of patterns of use for specific products and their chemical ingredients is critical for developing interventions to reduce these exposures, especially in vulnerable groups with an unequal burden of exposure

Chemical Relaxers and Hair-Straightening Products: Potential Targets for Hormone-Related Cancer Prevention and Control

Emerging data show that use of permanent hair dyes, chemical relaxers, and straightening products might contribute to increased risk of hormone-related cancers (1-5) and potentially breast tumors with features indicative of more aggressive phenotypes (6). Given the wide use of these products globally, they are an important source of exposure to potentially harmful chemicals, including endocrine-disrupting chemicals—to which we are ubiquitously exposed (7)—and mutagenic and/or genotoxic compounds. The unequal burden of exposure across populations plausibly contributes to cancer inequities as the groups with the greatest exposure also experience poorer cancer outcomes (8). For example, Black women use more hair and menstrual and/or intimate products, and Latina and Hispanic women use more makeup and cosmetics compared with other race and ethnicity groups (9,10), thereby increasing their exposures to hormonally active chemicals. Likewise, Black women are disproportionately diagnosed with aggressive breast tumors (eg, triple-negative, inflammatory), aggressive ovarian tumors (eg, high-grade serous carcinoma), and aggressive types of uterine and endometrial cancers (eg, nonendometrioid carcinoma) and have lower 5-year survival rates and higher mortality rates for these cancers relative to White women (11)