Association of Cultural Racism with Breast Cancer Survival Among United States Adults, 2018–2020

Using SEER data on 225,991 breast-cancer patients (12% non-Hispanic Black) and a validated state-level cultural racism factor (CRF), the authors find each unit increase in state-level cultural racism is associated with an 8% higher adjusted risk of death (aHR 1.08), strongest in the first year of follow-up. Results support the argument that population-level cultural racism — not just interpersonal bias — shapes breast-cancer survival outcomes.