What is the clinical evidence from this study?

Study design: Case-Control. Population: Breast cancer (n=685). Intervention: Social stressors and effortful coping vs. Matched controls. Primary outcome: Highest quartile of effortful coping (John Henryism scale).

What question did this study set out to answer?

The study aims to identify social, environmental, and biological risk factors contributing to breast cancer among Asian American women.

April 5, 2026

Abstract 5071: Stress and breast cancer risk among Asian American females: The CRANE Study

Key Result

Asian American women with breast cancer reported lower immigrant stress (20% vs 24%) and racism (15% vs 22%) but higher effortful coping (29% vs 24%) compared to matched controls.

Key Points

The study aims to identify social, environmental, and biological risk factors contributing to breast cancer among Asian American women.
Conducted a population-based case-control study in California, initiated in 2022.
Integrated epidemiologic, geospatial, and biospecimen data with medical and cancer registry records.
Matched controls by ethnicity, age, and region to AA women with recent breast cancer diagnoses.
Enrolled 317 breast cancer cases and 368 matched controls.
48% of cases were under 50 at diagnosis, with 70% diagnosed at stage I.
Cases were more likely to be foreign-born (72% vs. 54% in controls) and had higher BMI.
Lower levels of reported stress and racism among cases compared to controls, but higher effortful coping levels noted.

Study Design

Type

Case-Control (n=685)

Multicenter

Yes

Structured PICO

Do social stressors and effortful coping affect breast cancer risk in Asian American females?

Population

685 Asian American women (317 cases with recently-diagnosed breast cancer and 368 controls matched by ethnicity, age, and region) in California.

Comparator

Controls matched by ethnicity, age, and region

Outcome

Breast cancer risk associated with social stressors and effortful coping

In a case-control study of Asian American women, breast cancer cases reported lower levels of immigrant stress and racism but higher levels of effortful coping compared to controls.

Main Result

Absolute Event Rate: 29% vs 24%

Abstract

Abstract Background: Breast cancer incidence rates among Asian American (AA) women have risen rapidly, 2.3% annually since 2012, far outpacing the overall US trend. The increase is particularly stark for early-onset cases (50 years), at 2.9% per year since 2016. Significant increases were observed across nearly all AA groups, stages and subtypes, with especially sharp rises in late-stage and triple-negative breast cancer. Foreign-born AA now face higher risk relative to US-born AA, even after accounting for established risk factors. These evolving patterns point to emerging, unrecognized risk factors. The CRANE Study (Breast Cancer Risk among Asian Americans) investigates multilevel determinants, from environmental to biological, that drive the contemporary elevated risk in this population. This abstract describes preliminary social stressor results. Methods: The CRANE Study, initiated in 2022, is a population-based case-control study of breast cancer in AA in California. The study integrates epidemiologic data on established and emerging risk factors with geospatial data (including residential histories), cancer registry data, and biospecimens (saliva and hair), alongside access to medical records and tumor specimens. AA women with recently-diagnosed breast cancer are identified through the Greater Bay Area and Los Angeles County cancer registries. Controls, matched to cases by ethnicity, age, and region, are recruited using multiple modalities to represent the population at risk. Results: To date, 317 cases and 368 controls have been enrolled (39% Chinese, 18% Filipina, 9% Japanese, and 8% each Korean, South Asian, and Southeast Asian). Among cases, 48% were younger than age 50 at diagnosis, ranging from 16% among Japanese to 71% among Koreans. Most were diagnosed at stage I disease (70%). Tumor subtypes included 68% HR+/HER2-, 20% HER2+ (14% among Koreans to 29% among South Asians), and 8.5% triple-negative cancer. Compared to controls, cases were more likely to be foreign-born (72% vs. 54%) and less acculturated (65% vs. 81% English proficient), and have higher BMI (20% vs. 14% BMI27.5) and later menarche (50% vs. 45% at ≥13 years). However, cases reported lower levels of stress (20% vs 24% in the highest quartile of immigrant stress) and racism (15% vs. 22% in the highest quartile of anti-Asian racism) compared to controls. Despite reporting fewer stressors, more cases than controls expended higher levels of effortful coping on the John Henryism scale (29% vs. 24% in the highest quartile). Conclusions: The CRANE Study provides a unique and timely platform to investigate how environmental, social, and biological factors interact to shape breast cancer risk in this population. By focusing on AA, who are experiencing notable increases in early-onset and triple-negative breast cancers, CRANE aims to identify novel risk factors and pathways that may help explain emerging breast cancer trends in both AA and the broader US population. Citation Format: Scarlett L. Gomez, Katherine Lin, V. Wendy Setiawan. Stress and breast cancer risk among Asian American females: The CRANE Study abstract. In: Proceedings of the American Association for Cancer Research Annual Meeting 2026; Part 1 (Regular Abstracts); 2026 Apr 17-22; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2026;86(7 Suppl):Abstract nr 5071.

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