Miller, K. D. et al. Cancer treatment and survivorship statistics, 2019. CA Cancer J. Clin. 69, 363–385 (2019).
DeSantis, C. E., Miller, K. D., Sauer, A. G., Jemal, A. & Siegel, R. L. Cancer statistics for African Americans, 2019. CA Cancer J. Clin. 69, 211–233 (2019).
DeSantis, C. E. et al. Cancer statistics for African Americans, 2016: progress and opportunities in reducing racial disparities. CA Cancer J. Clin. 66, 290–308 (2016).
DeSantis, C. E. et al. Breast cancer statistics, 2019. CA Cancer J. Clin. 69, 438–451 (2019).
Giaquinto, A. N. et al. Breast cancer statistics 2024. CA Cancer J. Clin. 74, 477–495 (2024).
Saka, A. H. et al. Cancer statistics for African American and Black people, 2025. CA Cancer J. Clin. 75, 111–140 (2025).
Vick, A. D. & Burris, H. H. Epigenetics and health disparities. Curr. Epidemiol. Rep. 4, 31–37 (2017).
Dunn, B. K., Agurs-Collins, T., Browne, D., Lubet, R. & Johnson, K. A. Health disparities in breast cancer: biology meets socioeconomic status. Breast Cancer Res. Treat. 121, 281–292 (2010).
Shoemaker, M. L., White, M. C., Wu, M., Weir, H. K. & Romieu, I. Differences in breast cancer incidence among young women aged 20-49 years by stage and tumor characteristics, age, race, and ethnicity, 2004-2013. Breast Cancer Res. Treat. 169, 595–606 (2018).
Dietze, E. C., Sistrunk, C., Miranda-Carboni, G., O’Regan, R. & Seewaldt, V. L. Triple-negative breast cancer in African-American women: disparities versus biology. Nat. Rev. Cancer 15, 248–254 (2015).
Daly, B. & Olopade, O. I. A perfect storm: how tumor biology, genomics, and health care delivery patterns collide to create a racial survival disparity in breast cancer and proposed interventions for change. CA Cancer J. Clin. 65, 221–238 (2015).
McCall, M. K. et al. Symptom experience, management, and outcomes according to race and social determinants including genomics, epigenomics, and metabolomics (SEMOARS + GEM): an explanatory model for breast cancer treatment disparity. J. Cancer Educ. 35, 428–440 (2020).
Wieder, R., Shafiq, B. & Adam, N. African American Race is an independent risk factor in survival from initially diagnosed localized breast cancer. J. Cancer 7, 1587–1598 (2016).
Keegan, T. H. M. et al. Racial/ethnic and socioeconomic differences in short-term breast cancer survival among women in an integrated health system. Am. J. Public Health 105, 938–946 (2015).
Newman, L. A. et al. Meta-analysis of survival in African American and white American patients with breast cancer: ethnicity compared with socioeconomic status. J. Clin. Oncol. 24, 1342–1349 (2006).
Williams, D. R., Mohammed, S. A. & Shields, A. E. Understanding and effectively addressing breast cancer in African American women: unpacking the social context. Cancer 122, 2138–2149 (2016).
Bailey, Z. D. et al. Structural racism and health inequities in the USA: evidence and interventions. Lancet 389, 1453–1463 (2017).
McEwen, B. S. Central effects of stress hormones in health and disease: understanding the protective and damaging effects of stress and stress mediators. Eur. J. Pharmacol. 583, 174–185 (2008).
Miller-Kleinhenz, J. M. et al. Historical redlining, persistent mortgage discrimination, and race in breast cancer outcomes. JAMA Netw. Open 7, e2356879 (2024).
Warnecke, R. B. et al. Approaching health disparities from a population perspective: the National Institutes of Health Centers for Population Health and Health Disparities. Am. J. Public Health 98, 1608–1615 (2008).
Sangaramoorthy, M. et al. Association between neighborhood stressors and allostatic load in breast cancer survivors: the pathways study. Am. J. Epidemiol. kwae134. https://doi.org/10.1093/aje/kwae134 (2024).
Chen, J. C. et al. Association between neighborhood opportunity, allostatic load, and all-cause mortality in patients with breast cancer. J. Clin. Oncol. 42, 1788–1798 (2024).
Krieger, N. Discrimination and health inequities. Int. J. Health Serv. 44, 643–710 (2014).
Berger, M. & Sarnyai, Z. “More than skin deep”: stress neurobiology and mental health consequences of racial discrimination. Stress 18, 1–10 (2015).
Wang, F. et al. Allostatic load and risk of invasive breast cancer among postmenopausal women in the U.S. Prev. Med. 178, 107817 (2024).
Zhao, H., Song, R., Ye, Y., Chow, W. H. & Shen, J. Allostatic score and its associations with demographics, healthy behaviors, tumor characteristics, and mitochondrial DNA among breast cancer patients. Breast Cancer Res. Treat. 187, 587–596 (2021).
Shen, J. et al. Neighborhood disadvantage and biological aging biomarkers among breast cancer patients. Sci. Rep. 12, 11006 (2022).
Geronimus, A. T., Hicken, M., Keene, D. & Bound, J. Weathering” and age patterns of allostatic load scores among Blacks and Whites in the United States. Am. J. Public Health 96, 826–833 (2006).
Geronimus, A. T. et al. Do US black women experience stress-related accelerated biological aging? Hum. Nat. 21, 19–38 (2010).
Banegas, M. P. et al. For working-age cancer survivors, medical debt and bankruptcy create financial hardships. Health Aff. 35, 54–61 (2016).
Liu, B., Lee, F. F. & Boscoe, F. Residential mobility among adult cancer survivors in the United States. BMC Public Health 20, 1601 (2020).
Namin, S., Zhou, Y., McGinley, E. & Beyer, K. Residential history in cancer research: utility of the annual billing ZIP code in the SEER-Medicare database and mobility among older women with breast cancer in the United States. SSM Popul. Health 15, 100823 (2021).
Dawes D. The Political Determinants of Health. https://doi.org/10.56021/9781421437903 (Johns Hopkins University Press, 2020).
Hillier, A. E. Redlining and the Home Owners’ Loan Corporation. J. Urban Hist. 29, 394–420 (2003).
Greer, J. The Home Owners’ Loan Corporation and the development of the residential security maps. J. Urban Hist. 39, 275–296 (2013).
Woods, L. L. The Federal Home Loan Bank Board, Redlining, and the National Proliferation of Racial Lending Discrimination, 1921–1950. J. Urban Hist. 38, 1036–1059 (2012).
Cross, R. I., Huỳnh, J., Bradford, N. J. & Francis, B. Racialized housing discrimination and population health: a scoping review and research agenda. J. Urban Health 100, 355–388 (2023).
Williams, D. R. & Collins, C. Racial residential segregation: a fundamental cause of racial disparities in health. Public Health Rep. 116, 404–416 (2001).
Krieger, N. et al. Cancer stage at diagnosis, historical redlining, and current neighborhood characteristics: breast, cervical, lung, and colorectal cancers, Massachusetts, 2001–2015. Am. J. Epidemiol. 189, 1065–1075 (2020).
Bikomeye, J. C. et al. Historical redlining and breast cancer treatment and survival among older women in the United States. J. Natl. Cancer Inst. 115, 652–661 (2023).
Plascak, J. J. et al. Association between residence in historically redlined districts indicative of structural racism and racial and ethnic disparities in breast cancer outcomes. JAMA Netw. Open 5, e2220908 (2022).
Landrine, H. et al. Residential segregation and racial cancer disparities: a systematic review. J. Racial Ethn. Health Disparities. https://doi.org/10.1007/s40615-016-0326-9 (2016).
Smith, B. P. & Madak-Erdogan, Z. Urban neighborhood and residential factors associated with breast cancer in African American women: a systematic review. Horm Cancer 9, 71–81 (2018).
White-Means, S. & Muruako, A. GIS mapping and breast cancer health care access gaps for African American women. IJERPH 20, 5455 (2023).
Russell, E. F. et al. Metropolitan area racial residential segregation, neighborhood racial composition, and breast cancer mortality. Cancer Causes Control 23, 1519–1527 (2012).
Plascak, J. J. et al. Associations between neighborhood disinvestment and breast cancer outcomes within a populous state registry. Cancer 128, 131–138 (2022).
Cho, B. et al. Evaluation of racial/ethnic differences in treatment and mortality among women with triple-negative breast cancer. JAMA Oncol. 7, 1016 (2021).
Lubarsky, M. et al. Does structural racism impact receipt of NCCN guideline-concordant breast cancer treatment? Breast Cancer Res. Treat. 206, 509–517 (2024).
Lawson, M. B. et al. Multilevel factors associated with time to biopsy after abnormal screening mammography results by race and ethnicity. JAMA Oncol. 8, 1115–1126 (2022).
Molina, Y., Silva, A. & Rauscher, G. H. Racial/ethnic disparities in time to a breast cancer diagnosis: the mediating effects of health care facility factors. Med. Care 53, 872–878 (2015).
Miller-Kleinhenz, J. M. et al. Racial disparities in diagnostic delay among women with breast cancer. J. Am. Coll. Radiol. 18, 1384–1393 (2021).
Emerson, M. A. et al. Breast cancer treatment delays by socioeconomic and health care access latent classes in Black and White women. Cancer 126, 4957–4966 (2020).
Hu, X. et al. Racial differences in patient-reported symptoms and adherence to adjuvant endocrine therapy among women with early-stage, hormone receptor-positive breast cancer. JAMA Netw. Open 5, e2225485 (2022).
Lake, P. W., Conley, C. C., Pal, T., Sutton, S. K. & Vadaparampil, S. T. Anxiety and depression among Black breast cancer survivors: Examining the role of patient-provider communication and cultural values. Patient Educ. Couns. 105, 2391–2396 (2022).
Williams, D. R., Lawrence, J. A. & Davis, B. A. Racism and health: evidence and needed research. Annu. Rev. Public Health 40, 105–125 (2019).
Paradies, Y. et al. Racism as a determinant of health: a systematic review and meta-analysis. PLoS ONE 10, e0138511 (2015).
Gilbert, K. L., Ransome, Y., Dean, L. T., DeCaille, J. & Kawachi, I. Social capital, Black social mobility, and health disparities. Annu. Rev. Public Health 43, 173–191 (2022).
Plascak, J. J. et al. Visual cues of the built environment and perceived stress among a cohort of black breast cancer survivors. Health Place 67, 102498 (2021).
Woods-Giscombé, C. L. & Black, A. R. Mind-body interventions to reduce risk for health disparities related to stress and strength among African American women: the potential of mindfulness-based stress reduction, loving-kindness, and the NTU therapeutic framework. Complement. Health Pract. Rev. 15, 115–131 (2010).
American Psychological Association. APA Working Group on Stress and Health Disparities. Stress and Health Disparities: Contexts, Mechanisms, and Interventions Among Racial/Ethnic Minority and Low Socioeconomic Status Populations: (500202018-001). Published online https://doi.org/10.1037/e500202018-001 (2017).
Sternthal, M. J., Slopen, N. & Williams, D. R. Racial disparities in health: how much does stress really matter? Du Bois Rev. 8, 95–113 (2011).
United States Census Bureau. Historical Poverty Table 2: Poverty Status of People by Family Relationship, Race, and Hispanic Origin – 1959 to 2018. https://www.census.gov/data/tables/time-series/demo/income-poverty/historical-poverty-people.html (2019).
McEwen, B. & Seeman, T. Allostatic Load and Allostasis. Accessed 15 September 2020. https://macses.ucsf.edu/research/allostatic/allostatic.php (2009).
Nielsen, N. R. & Grønbæk, M. Stress and breast cancer: a systematic update on the current knowledge. Nat. Rev. Clin. Oncol. 3, 612–620 (2006).
Armaiz-Pena, G. N., Lutgendorf, S. K., Cole, S. W. & Sood, A. K. Neuroendocrine modulation of cancer progression. Brain Behav. Immun. 23, 10–15 (2009).
Chida, Y., Hamer, M., Wardle, J. & Steptoe, A. Do stress-related psychosocial factors contribute to cancer incidence and survival? Nat. Clin. Pract. Oncol. 5, 466–475 (2008).
Volden, P. A. & Conzen, S. D. The influence of glucocorticoid signaling on tumor progression. Brain, Behav. Immun. 30, 26–31 (2013).
Xing, C. Y. et al. Pre-diagnostic allostatic load and health-related quality of life in a cohort of Black breast cancer survivors. Breast Cancer Res. Treat. 184, 901–914 (2020).
Kish, J. K., Yu, M., Percy-Laurry, A. & Altekruse, S. F. Racial and ethnic disparities in cancer survival by neighborhood socioeconomic status in Surveillance, Epidemiology, and End Results (SEER) Registries. J. Natl. Cancer Inst. Monogr. 2014, 236–243 (2014).
Pan, H. Y. et al. Insurance status and racial disparities in cancer-specific mortality in the United States: a population-based analysis. Cancer Epidemiol. Biomark. Prev. 26, 869–875 (2017).
Warner, E. T. & Gomez, S. L. Impact of neighborhood racial composition and metropolitan residential segregation on disparities in breast cancer stage at diagnosis and survival between black and white women in California. J. Community Health 35, 398–408 (2010).
Hailu, E. M. et al. Longitudinal associations between discrimination, neighborhood social cohesion, and telomere length: the multi-ethnic study of atherosclerosis. J. Gerontol. Ser. A 77, 365–374 (2022).
Allen, A. M. et al. Racial discrimination, the superwoman schema, and allostatic load: exploring an integrative stress‐coping model among African American women. Ann. N. Y. Acad. Sci. 1457, 104–127 (2019).
Duran, D. G. & Pérez-Stable, E. J. Novel approaches to advance minority health and health disparities research. Am. J. Public Health 109, S8–S10 (2019).
Lewis, T. T., Cogburn, C. D. & Williams, D. R. Self-reported experiences of discrimination and health: scientific advances, ongoing controversies, and emerging issues. Annu Rev. Clin. Psychol. 11, 407–440 (2015).
Brondolo, E., Brady Ver Halen, N., Pencille, M., Beatty, D. & Contrada, R. J. Coping with racism: a selective review of the literature and a theoretical and methodological critique. J. Behav. Med 32, 64–88 (2009).
Taylor, T. R. et al. Racial discrimination and breast cancer incidence in US Black women: the Black Women’s Health Study. Am. J. Epidemiol. 166, 46–54 (2007).
Clark, R., Anderson, N. B., Clark, V. R. & Williams, D. R. Racism as a stressor for African Americans. A biopsychosocial model. Am. Psychol. 54, 805–816 (1999).
Woods-Giscombé, C. L. Superwoman schema: African American women’s views on stress, strength, and health. Qual. Health Res. 20, 668–683 (2010).
Watson, N. N. & Hunter, C. D. Anxiety and depression among African American women: the costs of strength and negative attitudes toward psychological help-seeking. Cult. Divers. Ethn. Minor. Psychol. 21, 604–612 (2015).
Watson, N. N. & Hunter, C. D. “I had to be strong”: tensions in the strong Black woman schema. J. Black Psychol. 42, 424–452 (2016).
Peek, M. E., Sayad, J. V. & Markwardt, R. Fear, fatalism and breast cancer screening in low-income African-American women: the role of clinicians and the health care system. J. Gen. Intern. Med. 23, 1847–1853 (2008).
McEwen B. S. Protective and damaging effects of stress mediators. N. Engl. J. Med. 338, 171–179 (1998).
Williams, D. R. & Mohammed, S. A. Discrimination and racial disparities in health: evidence and needed research. J. Behav. Med. 32, 20 (2009).
Powell, N. D., Tarr, A. J. & Sheridan, J. F. Review: psychosocial stress and inflammation in cancer. Brain Behav. Immun. 30, S41–S47 (2013).
Armaiz-Pena, G. N., Cole, S. W., Lutgendorf, S. K. & Sood, A. K. Neuroendocrine influences on cancer progression. Brain Behav. Immun. 30, S19–S25 (2013).
Spiegel, D., Bloom, J. R., Kraemer, H. C. & Gottheil, E. Effect of psychosocial treatment on survival of patients with metastatic breast cancer. Lancet 2, 888–891 (1989).
Xing, C. Y. et al. Prediagnostic allostatic load as a predictor of poorly differentiated and larger sized breast cancers among Black women in the women’s circle of health follow-up study. Cancer Epidemiol. Biomark. Prev. 29, 216–224 (2020).
Cole, S. W. Social regulation of human gene expression: mechanisms and implications for public health. Am. J. Public Health 103, S84–S92 (2013).
Cole, S. W. The conserved transcriptional response to adversity. Curr. Opin. Behav. Sci. 28, 31–37 (2019).
Siddharth, S. & Sharma, D. Racial disparity and triple-negative breast cancer in African-American women: a multifaceted affair between obesity, biology, and socioeconomic determinants. Cancers 10, 514 (2018).
Cozier, Y. C. et al. Racism, segregation, and risk of obesity in the Black Women’s Health Study. Am. J. Epidemiol. 179, 875–883 (2014).
Brown, K. A. Metabolic pathways in obesity-related breast cancer. Nat. Rev. Endocrinol. 17, 350–363 (2021).
Deshmukh, S. K. et al. Resistin and interleukin-6 exhibit racially-disparate expression in breast cancer patients, display molecular association and promote growth and aggressiveness of tumor cells through STAT3 activation. Oncotarget 6, 11231–11241 (2015).
Epel, E. S. et al. Accelerated telomere shortening in response to life stress. Proc. Natl. Acad. Sci. USA 101, 17312–17315 (2004).
Hertzman, C. The biological embedding of early experience and its effects on health in adulthood. Ann. N. Y. Acad. Sci. 896, 85–95 (1999).
McEwen, B. S. & Seeman, T. Protective and damaging effects of mediators of stress. Elaborating and testing the concepts of allostasis and allostatic load. Ann. N. Y Acad. Sci. 896, 30–47 (1999).
Hara, M. R. et al. A stress response pathway regulates DNA damage through β2-adrenoreceptors and β-arrestin-1. Nature 477, 349–353 (2011).
Eismann, E. A., Lush, E. & Sephton, S. E. Circadian effects in cancer-relevant psychoneuroendocrine and immune pathways. Psychoneuroendocrinology 35, 963–976 (2010).
Sephton, S. E. Diurnal cortisol rhythm as a predictor of breast cancer survival. J. Natl. Cancer Inst. 92, 994–1000 (2000).
Feng, Z. et al. Chronic restraint stress attenuates p53 function and promotes tumorigenesis. Proc. Natl. Acad. Sci. USA 109, 7013 (2012).
Spiegel, D. Mind matters in cancer survival. Psycho Oncol. 21, 588–593 (2012).
Coelho, M. et al. β-Adrenergic modulation of cancer cell proliferation: available evidence and clinical perspectives. J. Cancer Res. Clin. Oncol. 143, 275–291 (2017).
Cole, S. W. & Sood, A. K. Molecular pathways: beta-adrenergic signaling in cancer. Clin. Cancer Res. 18, 1201–1206 (2012).
Cole, S. W., Nagaraja, A. S., Lutgendorf, S. K., Green, P. A. & Sood, A. K. Sympathetic nervous system regulation of the tumour microenvironment. Nat. Rev. Cancer 15, 563–572 (2015).
Yee, L. D., Mortimer, J. E., Natarajan, R., Dietze, E. C. & Seewaldt, V. L. Metabolic health, insulin, and breast cancer: why oncologists should care about insulin. Front. Endocrinol. 11, https://doi.org/10.3389/fendo.2020.00058 (2020).
Mohanty, S. S. & Mohanty, P. K. Obesity as potential breast cancer risk factor for postmenopausal women. Genes Dis. 8, 117–123 (2021).
Taroeno-Hariadi, K. W., Hardianti, M. S., Sinorita, H. & Aryandono, T. Obesity, leptin, and deregulation of microRNA in lipid metabolisms: their contribution to breast cancer prognosis. Diabetol. Metab. Syndr. 13, https://doi.org/10.1186/s13098-020-00621-4 (2021).
Esteller, M. CpG island hypermethylation and tumor suppressor genes: a booming present, a brighter future. Oncogene 21, 5427–5440 (2002).
Esteller, M. Epigenetic gene silencing in cancer: the DNA hypermethylome. Hum. Mol. Genet. 16, R50–R59 (2007).
Das, P. M. & Singal, R. DNA methylation and cancer. JCO 22, 4632–4642 (2004).
Nesset, K. A., Perri, A. M. & Mueller, C. R. Frequent promoter hypermethylation and expression reduction of the glucocorticoid receptor gene in breast tumors. Epigenetics 9, 851–859 (2014).
Barcelona de Mendoza, V., Huang, Y., Crusto, C. A., Sun, Y. V. & Taylor, J. Y. Perceived racial discrimination and DNA methylation among African American women in the InterGEN study. Biol. Res. Nurs. 20, 145–152 (2018).
Maroni, P., Matteucci, E., Bendinelli, P. & Desiderio, M. Functions and epigenetic regulation of Wwox in bone metastasis from breast carcinoma: comparison with primary tumors. Int. J. Mol. Sci. 18, 75 (2017).
Puterman, E. et al. Lifespan adversity and later adulthood telomere length in the nationally representative US Health and Retirement Study. Proc. Natl. Acad. Sci. USA 113, E6335–E6342 (2016).
Kiecolt-Glaser, J. K. & Glaser, R. Psychological stress, telomeres, and telomerase. Brain Behav. Immun. 24, 529–530 (2010).
Romano, G. H. et al. Environmental stresses disrupt telomere length homeostasis. PLOS Genet. 9, e1003721 (2013).
Ennour-Idrissi, K., Maunsell, E. & Diorio, C. Telomere length and breast cancer prognosis: a systematic review. Cancer Epidemiol. Biomark. Prev. 26, 3–10 (2017).
Duggan, C. et al. Change in peripheral blood leukocyte telomere length and mortality in breast cancer survivors. J. Natl. Cancer Inst. 106, dju035 (2014).
Weischer, M. et al. Short telomere length, cancer survival, and cancer risk in 47102 individuals. J. Natl. Cancer Inst. 105, 459–468 (2013).
Obeng-Gyasi, S. et al. Association of allostatic load with all-cause mortality in patients with breast cancer. JAMA Netw. Open 6, e2313989 (2023).
Barnard, M. E. et al. Psychosocial stressors and breast cancer gene expression in the Black Women’s Health Study. Breast Cancer Res. Treat. 204, 327–340 (2024).
Martini, R. et al. African ancestry-associated gene expression profiles in triple-negative breast cancer underlie altered tumor biology and clinical outcome in women of African descent. Cancer Discov. 12, 2530–2551 (2022).
Biancolella, M. et al. Breast cancer in West Africa: molecular analysis of BRCA genes in early-onset breast cancer patients in Burkina Faso. Hum. Genom. 15, 65 (2021).
Nair, N. M. et al. The African-specific variant in the Duffy Antigen Receptor for Chemokines (DARC) gene, CD8+ T-cell density and Aggressive Breast Cancer Subtypes in Black Women. Cancer Epidemiol. Biomark. Prev. https://doi.org/10.1158/1055-9965.epi-25-0454 (2025).
Martini, R. et al. Investigation of triple-negative breast cancer risk alleles in an International African-enriched cohort. Sci. Rep. 11, 9247 (2021).
Cruceriu, D., Baldasici, O., Balacescu, O. & Berindan-Neagoe, I. The dual role of tumor necrosis factor-alpha (TNF-α) in breast cancer: molecular insights and therapeutic approaches. Cell Oncol. 43, 1–18 (2020).
Glaser, R. & Kiecolt-Glaser, J. K. Stress-induced immune dysfunction: implications for health. Nat. Rev. Immunol. 5, 243–251 (2005).
Reiche, E. M. V., Morimoto, H. K. & Nunes, S. M. V. Stress and depression-induced immune dysfunction: implications for the development and progression of cancer. Int. Rev. Psychiatry 17, 515–527 (2005).
Cohen, S., Janicki-Deverts, D. & Miller, G. E. Psychological stress and disease. JAMA 298, 1685–1687 (2007).
Zajac, K. K., Malla, S., Babu, R. J., Raman, D. & Tiwari A. K. Ethnic disparities in the immune microenvironment of triple negative breast cancer and its role in therapeutic outcomes. Cancer Rep. 6, https://doi.org/10.1002/cnr2.1779 (2023).
Argentieri, M. A., Nagarajan, S., Seddighzadeh, B., Baccarelli, A. A. & Shields, A. E. Epigenetic pathways in human disease: the impact of DNA methylation on stress-related pathogenesis and current challenges in biomarker development. EBioMedicine 18, 327–350 (2017).
Tyrka, A. R., Price, L. H., Marsit, C., Walters, O. C. & Carpenter, L. L. Childhood adversity and epigenetic modulation of the leukocyte glucocorticoid receptor: preliminary findings in healthy adults. PLoS One 7, e30148 (2012).
Parente, V., Hale, L. & Palermo, T. Association between breast cancer and allostatic load by race: National Health and Nutrition Examination Survey 1999-2008. Psychooncology 22, 621–628 (2013).