Racial Disparities in Triple Negative Breast Cancer

Toward a Causal Architecture Approach

Scott D. Siegel; Madeline M. Brooks; Shannon M. Lynch; Jennifer Sims-Mourtada; Zachary T. Schug; Frank C. Curriero


Breast Cancer Res. 2022;24(37) 

In This Article


This study provides preliminary evidence to suggest that the ICE-Race metric can efficiently identify census tracts with higher odds of TNBC due to both compositional and contextual effects. Preliminary evidence also suggests that the contextual effects may be driven, at least in part, by potentially modifiable metabolic exposures, such as alcohol use and obesity. Krieger and colleagues have called for including ICE metrics in cancer registries to facilitate the monitoring of cancer inequities.[29] Going further, the use of ICE metrics can help to advance the study of racial disparities in breast cancer from a methodology based on traditional risk factors to one grounded in a causal architecture framework. Rather than studying individual risk factors in isolation without considering neighborhood effects, the use of large and representative pooled patient cohorts can be employed to evaluate the multilevel, multifactorial relationships between exposures and TNBC. Such efforts could be complemented by basic and translational research designed to delineate mechanisms of pathophysiology and facilitate biomarker discovery. Together, these lines of research could inform risk stratification approaches to improve early detection, more effectively target risk factor modification interventions to the communities at greatest risk, and advance health equity.[75,76]