Applying the Stress and ‘Strength’ Hypothesis to Black Women's Breast Cancer Screening Delays

Abstract

Associations between stress and breast cancer highlight stressful life events as barriers to breast cancer screening, increased stress due to a breast cancer scare or diagnosis, or the immunosuppressive properties of stress as a risk factor for breast cancer occurrence. Little is known, however, about how women’s reactions to stressful life events impact their breast health trajectory. In this study, we explore how reactions to stressors serve as a potential barrier to breast cancer screening among Black women. We apply a gender-specific, culturally responsive stress-process framework, the Stress and ‘Strength’ Hypothesis (“strength hypothesis”), to understand links between the ‘Strong Black Woman role’ role, Black women’s stress reactions and their observed screening delays. We conceptualize strength as a culturally prescribed coping style that conditions resilience, self-reliance and psychological hardiness as a survival response to race-related and gender-related stressors. Using qualitative methods, we investigate the potential for this coping mechanism to manifest as extraordinary caregiving, emotional suppression and self-care postponement. These manifestations may result in limited time for scheduling and attending screening appointments, lack of or delay in acknowledgement of breast health symptoms and low prioritization of breast care. Limitations and future directions are discussed.

Striking life events associated with primary breast cancer susceptibility in women: a meta-analysis study

“…Although many studies have assessed the relationship between the incidence of breast cancer and life events, both epidemiologically and etiologically, the results have been inconsistent [35-37]. Several of these studies reported that life events were significantly associated with breast cancer risk [37,38]. Evidence has emerged showing that these life events may affect the hypothalamic-pituitary-adrenal axis, resulting in endocrine system disorders, increased cortisol concentrations, and reductions in antineoplastic activity [7,8,39].…”

Whose Stress is Making Me Sick? Network-stress and Emotional Distress in African-American Women

“…African-American women have often adopted a behavioral script of "strength," encompassing self-reliance, self-sacrifice, and self-silence, to enhance survival in racist and sexist contexts that have existed over generations in the USA (Black & Peacock, 2011). The caregiving roles of many African-American women can result in complex patterns of adaptation, whereby they take on the needs of others while minimizing, neglecting, or postponing personal needs and self-care (Black & Peacock, 2011;Black & Woods-Giscombé, 2012;Carthron, Bailey, & Anderson, 2014;Carthron, Johnson, Hubbart, Strickland, & Nance, 2010;Samuel-Hodge, Skelly, Headen, Carter-Edwards, 2005;Woods-Giscombé, 2010).…”

To be young, Black, and living with breast cancer: a systematic review of health-related quality of life in young Black breast cancer survivors

“…Research on the nuanced experiences of life stressors among Black women suggest that Superwoman Schema, or perceived obligations to present an image of strength, suppress emotions, resist support from others, achieve success with inadequate resources, and prioritize caregiving over self-care can adversely affect health-promoting behaviors and HRQOL [35, 37]. Moreover, Network Stress, or the stress experienced by Black women as a result of life challenges experienced by family members and friends [36], might magnify ways in which stress negatively influences aspects of HRQOL in this population.…”