A New Theory for Racial Disparity in Breast Cancer Deaths

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Introduction

One of the big mysteries in the cancer field is why young black women have about twice the death rate from breast cancer as white women. This paper will propose a new theory for explaining this increased death outcome. 

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What could be causing black women to be more likely to die from breast cancer than white women? Current thinking has gathered the usual suspects. One is unequal access to healthcare, with black women having less preventative services and early detection and treatment. This results in black women getting treatment for later stage disease, with worse outcomes. 

Black women also have different proportions of cancer types than white women, with more triple-negative cases that have worse outcomes. And due to many factors, black people, on average, have higher incidence of other health problems, or co-morbidities, including diabetes, hypertension, and obesity. These impact breast cancer survival.

But these factors alone cannot explain why black women are more likely to die from breast cancer than white women. 

However, one factor that affects breast physiology has been ignored in all of the medical literature on this issue, which relates to the impact of tight clothing on the breasts. Specifically, research has ignored the impact of tight bras.

Tight Bras and Lymphatic Impairment

The problem with tight bras is that they can impair lymphatic circulation, which is especially susceptible to pressure from garments. This is why patients with a tendency towards lymphedema are advised not to wear tight clothing. Daily clothing-caused constriction of the breast lymphatics with the use of bras results in lymph fluid congestion, as the pressure from the bra constricts the easily compressed lymphatic vessels. 

The purpose of the lymphatics is to drain the tissues of fluid, toxins, cell debris, bacteria, viruses, and cancer cells; to provide a pathway for the immune system to attack any developing infections or tumors; and to keep the circulation going for tissue repair. It is the circulatory pathway of the immune system. When constricted, the lymphatics are impaired in their ability to transport fluid and white blood cells, and the tissue becomes congested, low in oxygen, and high in toxic waste and other toxic substances. Tissue repair also becomes more difficult with a constricted lymphatic system. Infections and cancers can thrive when lymph is stagnant. 

Lymph Stasis and Cancer

Stagnant lymph is also called lymph stasis, and has been associated with cancer development since at least the 1930s. Recent research has shown that lymph stasis promotes tumor growth.  According to a 2018 study, “(t)hese findings come as no surprise to us who for a long time have been aware that alterations in regional lymphatic flow may produce dysregulation in skin immune function and consequent oncogenesis. In fact, since 2002, our team has held the view that lymphedematous areas are immunologically vulnerable sites for the development of neoplasms as well as infections and immune-mediated diseases. In recent years, increasing evidence has confirmed this assumption.”

According to a recent review of the lymphatic system in the Annual Review of Biomedical Engineering, entitled, The Lymphatic System in Disease Processes and Cancer Progression, “Advances in our understanding of the structure and function of the lymphatic system have made it possible to identify its role in a variety of disease processes. Because it is involved not only in fluid homeostasis but also in immune cell trafficking, the lymphatic system can mediate and ultimately alter immune responses. Our rapidly increasing knowledge of the molecular control of the lymphatic system will inevitably lead to new and effective therapies for patients with lymphatic dysfunction. In this review, we discuss the molecular and physiological control of lymphatic vessel function and explore how the lymphatic system contributes to many disease processes, including cancer and lymphedema.

This means that tight bras can increase cancer incidence by impairing lymphatic function. This toxifies the tissue, and impairs healing and immune function, including reduced cancer recognition and destruction. Numerous studies worldwide have now shown a bra-cancer link. 

Different Skin, Different Scars

However, not all women will react to the constriction and compression of the bra in the same way. Some women, particularly women of color, have different skin properties that affect how the skin responds to trauma, rubbing, and irritation from tight bras.  These women are more likely to form thick, raised scars, called keloid or hypertrophic scars. 

These extreme scars can develop from surgical cuts, but also can form on susceptible skin from tension or pulling on the skin, or from repeated compression and rubbing, as happens with bras and their underwires and straps. Wherever a bra leaves marks in the skin, it is a place where scarring can begin for people prone to developing these types of scars. Wherever the bra pushes the breasts to relocate them for fashion reasons, it creates tension in the skin that can result in scarring. 

The scarring is the product of overly active cells, called fibroblasts, which make collagen for the skin and connective tissue when a wound heals. Normally, the fibroblasts fill in the wound area and stop growing, as the wound is sealed with collagen fibers composing scar tissue.  However, people of color have a genetic predisposition to over-active fibroblast activity when healing wounds, leading to excessive scar collagen deposits and a big, thick, raised scar tissue. This is the hypertrophic scar. Sometimes, this scar continues to grow outside the limits of the wound as it heals, resulting in a keloid scar. 

Bras and Scars

This means that people with a greater tendency for keloid scar formation may be more harmed by tight clothing than someone who heals without excessive scar formation. In other words, black women and other women of color face greater risk of big scars from tight bras. 

This is more than a cosmetic issue. Scarring causes a disruption of the lymphatic system. The lymphatics are tiny capillaries which begin in the tissue spaces and drain lymph fluid through the extracellular matrix, which is a scaffolding and structure for the tissue. Increased collagen in the extracellular matrix of the breast tissue, associated with scarring from tight bras, creates a resistance to this flow of lymph. This causes fluid congestion in the breasts, which manifests as pain and cysts. Over time, as toxins accumulate and immunity wanes, disease develops.

This means that people with a tendency towards keloid and hypertrophic scar development have a higher risk of disease in general due to an overactive scar formation mechanism and consequently reduced immune function from lymphatic impairment.  

Keloids and Cancer

In fact, a big study in the UK looked for health problems associated with people who develop keloid and hypertrophic scars. The study, entitled, Comorbidities of Keloid and Hypertrophic Scars Among Participants in UK Biobank, found that people who get these scars also are more likely to suffer from lots of problems. Regarding the breasts, this includes inflammatory breast disease, breast pain, lump or mass in the breast, and breast cancer. 

This means that women prone to keloids also are more prone to cancer and other health problems. This also means that these women suffer more from bra constriction than women who scar less.

When a tight bra compresses, irritates, and rubs against the breasts everyday, for hours each day, year after year, there will be a skin response to repair the damage. The skin may thicken or scar. For some women with keloids, their skin response to the bra could include higher collagen in the skin, with scar tissue forming in response to the repeated irritation and rubbing, which interferes with proper lymphatic circulation. This increases cancer risk, and reduces the ability of the immune system to fight cancer once it appears. 

The impact of tight bras on lymphatic circulation may be why women of color have higher death rates from breast cancer. Their breasts are more damaged by bras than white women, who usually do not have scarring problems. 

Pressurized Scars

You would expect easily-scarring women to possibly show greater signs of compression from the bra, such as welts or indentations or overt scars, outlining the compressive surfaces of the garment. 

However, these scars may not be obvious, due to the bra. Let me explain. 

One popular treatment of keloid and hypertrophic scars is to apply pressure to the scar. This results in lower oxygen in the scar tissue beneath the compression, which causes death of some of the fibroblast cells that make the excess collagen. Eventually, the compression, if not too severe, will reduce the scar size. If the compression is too tight, it can cause tissue necrosis. 

This means that the bra can create scars, by compressing and constricting the breast tissue; and bras can control scars, by compressing and damaging the scar-producing fibroblasts. This may reduce the appearance of scars from the bra on the surface of the skin. However, beneath the surface, the chronically compressed skin will have increased collagen and some scarring. 

Scars Reduce Immunity and Repair

Once a woman develops breast cancer, her ability to recover and heal from the tumor, surgery, chemotherapy, and/or radiation therapy will be directly related to the health of her lymphatics. It stands to reason that the greater the damage to the lymphatics prior to getting cancer, the lower would be the survival rate. 

Unfortunately, the entire issue of bras and breast cancer is being deliberately ignored by the cancer industry in the US, so the impact of tight bras is overlooked. As a result, the racial disparity in the impact of bras due to differences in scar formation has also been overlooked. 

Higher Breast Cancer Incidence, too?

If black women are more harmed by bras to lower survival rates, then they should also increase incidence rates from bras in black women. That is, if a black woman and white woman of comparable size both wore the same tightness bra for a long period of time, then the black woman would theoretically suffer more harm due to an over-reactive scar formation process, resulting in greater lymphatic impairment.  Surprisingly, however, the incidence of breast cancer is comparable between races, while the death rate is higher for people of color. Why is the incidence rate the same regardless of race?

The answer may be that, while the incidence is comparable, there are numerous factors that increase risk besides bras which may be different between racial groups. Obviously, genetics also plays a key part, particularly regarding the BRCA gene mutations that increase cancer incidence. According to current research, black women have lower prevalence of harmful BRCA gene mutations compared to white women. This means something else is raising the risk for black women to compensate for lower BRCA mutation problems, and still keep the incidence rate the same as for white women.  The impact of tight bras on tissue scarring may be that other factor. 

Bras Usage is an Important Variable 

More research is clearly needed. But the impact of bras on the breasts must be included as a major variable. 

How tightly are black women wearing bras compared to white women? How long are they worn daily? What is the material of the garment? Is it irritating and made of synthetic fabric, which can leach toxic and irritating chemicals into the skin? Are there cultural differences between the way women use bras? How early in life do they start wearing them? 

You cannot understand why some women get breast cancer and others do not until you understand the physiological impact of tight bras on breasts. Breasts that have been chronically constricted, pushed, and scarred by bras for hours everyday, for years on end, from puberty onwards, are not the same as natural, bra-free breasts. You must also be sensitive to cultural differences in bra usage and body image, as well as racial differences in scar formation and other skin reactions to tight bras.

Until the factor of bra usage is considered in breast cancer research, there will continue to be confusion, especially regarding the cultural cause of this disease. The current medical model is focused on the biochemistry of cancer and how to manipulate that chemistry with drugs. It completely ignores the simple mechanical effect of tight bras on the breasts. It is like ignoring smoking when researching lung cancer.

Biochemistry Cannot Solve a Mechanical Problem 

This biochemical approach will not solve, or address, the mechanical problem of tight bras. If the lymphatics are compressed and constricted by a bra, no drug will end that mechanical problem. Until medicine responsibly addresses this issue with further research and warnings to women to avoid tight bras, breast cancer statistics will continue to stay high. 

Women of Color Suffer the Most from Bras

Unfortunately, women of color will disproportionately suffer from the current medical industry resistance to considering the impact of tight bras on breast pathophysiology. The above discussion presents a physiological mechanism that explains some of the racial disparity between breast cancer deaths. It explains how tight clothing can cause scarring and lymphatic impairment, and how people who develop keloid scars can be more impacted by tight clothing. But until all women hear this information, they will continue to harm their breasts inadvertently and ignorantly with constrictive bras. And women of color will suffer the most, as usual.

The medical community must stop its defensive and dogmatic rejection of the bra-cancer link, acknowledge that numerous studies do show a link, and call for further research into bras and other tight clothing and their effect on lymphatic circulation. Women have a right to know that their bra choices can put their health and lives at risk. And women of color, especially, need to know that compressive clothing can cause scarring that can lead to tissue breakdown, and possibly higher death rates from breast cancer. 

That’s too high a price for women to pay for fashion.  

Other References:

  • 1991 Harvard study (CC Hsieh, D Trichopoulos (1991). Breast size, handedness and breast cancer risk. European Journal of Cancer and Clinical Oncology 27(2):131-135.). This study found that, “Premenopausal women who do not wear bras had half the risk of breast cancer compared with bra users…”
  • 1991-93 U.S. Bra and Breast Cancer Study by Singer and Grismaijer, published in Dressed To Kill: The Link Between Breast Cancer and Bras (Second Edition, Square One Publishers, 2018). Found that bra-free women have about the same incidence of breast cancer as men. 24/7 bra wearing increases incidence over 100 times that of a bra-free woman.
  • Singer and Grismaijer did a follow-up study in Fiji, published in Get It Off! (ISCD Press, 2000). Found 24 case histories of breast cancer in a culture where half the women are bra-free. The women getting breast cancer were all wearing bras. Given women with the same genetics and diet and living in the same village, the ones getting breast disease were the ones wearing bras for work.
  • 2011 a study was published, in Spanish, confirming that bras are causing breast disease and cancer.  It found that underwired and push-up bras are the most harmful, but any bra that leaves red marks or indentations may cause disease.
  • 2016 Brassiere wearing and breast cancer risk: A systematic review and meta-analysis  World J Meta-Anal. Aug 26, 2015; 3(4): 193-205  This systematic review and meta-analysis aimed to evaluate the association between 8 areas of brassiere-wearing practices and the risk of breast cancer. Twelve case-control studies met inclusion criteria for review. The meta-analysis shows statistically significant findings to support the association between brassiere wearing during sleep and breast cancer risk.
  • 2018 Lymph stasis promotes tumor growth Journal of Dermatological Science “(t)hese findings come as no surprise to us who for a long time have been aware that alterations in regional lymphatic flow may produce dysregulation in skin immune function and consequent oncogenesis. In fact, since 2002, our team has held the view that lymphedematous areas are immunologically vulnerable sites for the development of neoplasms as well as infections and immune-mediated diseases. In recent years, increasing evidence has confirmed this assumption.”
  • 2018 How Bras Cause Lymph Stasis and Breast Cancer Academic.edu  “Recent studies are showing that lymph stasis causes cancer by reducing immune function. This article draws on these studies to further explain how constriction from tight bras results in lymphatic impairment in the breasts and an increased incidence of breast cancer.
  • 2019  Wearing Brassiere – A Less Well Known Factor Associated with Breast Cancer in Women Nurs Midwifery J 2019, 16(12) 891-901. Wearing of brassiere is also a lifestyle-related habit that has sparked many debates today as a risk factor for breast cancer in women. This study was conducted to determine the behavioral Habits of wearing brassiere in women with and without breast cancer. Conclusion: The findings of this study revealed differences in some behavioral habits of wearing brassieres in women with and without breast cancer. So, in preventive interventions for breast cancer, women’s education should be considered in order to be aware of the proper behavioral habits in wearing brassieres.

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