Chi-Chen Hong, PhD

Understanding the molecular drivers of aggressive breast cancer in Black women and how these are different in white women.

Impact

Black women are 42 percent more likely to die of their breast cancer than white women. Those diagnosed with breast cancer are more likely to be younger than newly diagnosed white women and are two times more likely to be diagnosed with triple-negative breast cancer (TNBC), an aggressive subtype of the disease. Drs. Hong and Ambrosone are investigating several biological and lifestyle factors that may influence the incidence of TNBC in Black women. This work may provide new insights at the population level into why some women develop more aggressive breast tumors so that personalized prevention and treatment can be designed.

Progress Thus Far

Drs. Hong and Ambrosone initiated the North South Breast Cancer Study (NSBCS) to be able perform comparable analyses in both Black women and White women. As of 2025, 2,080 White and 666 Black participants have enrolled in the study and completed interviews and retrieval of tumor tissues from hospitals is ongoing. One question Drs. Hong and Ambrosone are investigating is the role of psychosocial factors in the cause of more aggressive tumors, particularly with a focus on the breast cancer tumor immune microenvironment (TIME). The questionnaire for NSBCS includes several assessments related to stress, worry, coping and resiliency, as well as sleep and financial health. In collaboration with BCRF investigator Dr. Neha Goel at Memorial Sloan Kettering Cancer Center, the team is also evaluating factors related to neighborhood – perceived social cohesion, perceived neighborhood order and disorder and perception of safety while walking, as well as perceived discrimination. Drs. Hong and Ambrosone also formed a collaboration with BCRF investigator Dr. Annette Stanton and included assessments for the Strong Black Woman Syndrome, an archetype of how Black women should act, characterized by emotional restraint, independence, and caretaking. As expected, Black women had higher scores for depression and financial toxicity and had more negative perceptions of their neighborhoods.

What’s next

Building upon their findings so far, Drs. Ambrosone and Hong will extend and deepen analysis of psychosocial and neighborhood factors in relation to the TIME and breast cancer outcomes. In the coming year, the team will conduct analyses to examine Strong Black Woman Syndrome in depth in the study participants, particularly associations with depression and anxiety. In the coming year, the team will fully evaluate factors associated with Strong Black Woman Syndrome correlated them with other factors in Black women in NSBCS. Additionally, the team is planning to evaluate participant perceptions of their neighborhoods with several measures in the NSBCS survey. Finally, the team will explore data from the Women’s Circle of Health Study (WCHS), which aims to evaluate factors explaining the earlier age at diagnosis and the more aggressive nature of breast cancer among Black women compared to White women. Because the WCHS survey includes the same questions regarding neighborhood perceptions, they will use the genome-wide data collected as part of WCHS to examine how these psychosocial factors affect changes in gene expression.