Investigating Breast Cancer Outcomes in Haitian Immigrants

PROJECT SUMMARY Black women have the highest breast cancer death rates among all racial and ethnic groups, with a 40% higher mortality compared to White women. The burden of breast cancer has surged in the US and in countries in Latin America and the Caribbean. One-third of South Florida's Black population identifies as Haitian and/or

Afro-Caribbean. Previous studies have shown that Haitian women diagnosed with breast cancer in Haiti fare significantly worse than Haitian immigrants in Miami, marked by advanced stage and younger age diagnosis, more ER-negative tumors, and limited access to vital treatments. These findings underscore the significance of

healthcare access and treatment modalities, yet the differences in age and types of tumors suggest potentially distinct disease pathways as a driver. This raises the question as to whether there are short-term effects of immigration on breast cancer incidence and biology amongst Haitian women with breast cancer in Haiti and in

Miami. In this proposal, I aim to leverage existing methylation data on the saliva and tumors of Haitians with breast cancer living in Haiti, living in the US, and of US-born Black women living in the US, to evaluate the effects of immigration on their methylation profile and subsequent tumor characteristics. Additionally, in our

cohorts of Black women with breast cancer we observe survival disparities between the Afro-Caribbean and US-born groups. Preliminary analysis of breast cancer outcomes amongst Black patients at the University of Miami showed that Haitian patients had worse overall survival compared to other Caribbean countries. We

observed similar poor outcomes for USB women compared to other Caribbean immigrants. Haitian immigrants, as a triple minority group—Black, foreign-born, often speaking Haitian Creole—face unique challenges that may lead to higher levels of stress and discrimination compared to other Black immigrant groups. In this

proposal, I will leverage access to the African Cancer Genome Registry to assess the association between perceived stress and discrimination and aggressive tumor characteristics (receptor status, advanced disease) amongst Black immigrant women in Miami, with country of birth and language as mediators. This study will

uncover the intricate layers of stress and biologic influences (output as epigenetic) shaping the survival odds of Haitian immigrant women with breast cancer, highlighting their unique challenges within the broader landscape of Black immigrant health disparities. The interdisciplinary nature of this study will allow me to gain essential

skills for examining health disparities through an intersectional lens, as articulated by the NIMHD research frameworks.