Author's School

Brown School of Social Work

Author's Department/Program

Social Work


English (en)

Date of Award

Summer 9-2-2013

Degree Type


Degree Name

Doctor of Philosophy (PhD)

Chair and Committee

Sarah Gehlert


Compared to other subtypes of breast cancer, triple-negative breast cancer: TNBC) accounts for a disproportionate number of metastatic cases and cancer deaths. Glaring disparities are present in the occurrence of TNBC, such that those diagnosed are more likely to be African American: prevalence of 26% vs. 16% in non-African Americans) and premenopausal: 24% vs. 15% postmenopausal). A critical factor to consider regarding the disparities associated with TNBC is the evidence documenting the link between psychosocial stress over the life course and the occurrence of large, aggressive tumors that are characteristic of this subtype. Because issues such as crime, isolation, stress, discrimination, and other factors associated with poverty have been found to significantly affect etiology of breast cancer among young, African American women, it is critical to also consider these issues after diagnosis occurs. Despite the fact that many of these factors impact the etiology of TNBC, little is known about how these factors come into play once the diagnosis has occurred.

The present study qualitatively explores the critical biopsychosocial history and current environment of women facing such a diagnosis in order to shed light on the experience of TNBC. Using a grounded theory approach, in-depth, qualitative interviews were conducted with six women with TNBC and with a comparison group of six women with ER+ breast cancer. A prospective, longitudinal design was used with all women in the study to assess change over time and to cultivate prolonged engagement with participants. Data collection occurred in three waves, which corresponded with three critical points of the cancer care trajectory. Findings from this study demonstrate that the following stressors and strengths were unique for women with TNBC as compared to women with ER+ breast cancer: burden carriers throughout the life course, distant/strained relationships with mothers, absent fathers, experiences of sudden, unexpected deaths of loved ones, limited engagement in a spiritual community, limited engagement in neighborhood/community, and young age at time of diagnosis. Findings from these interviews resulted in a preliminary conceptual framework for understanding the contextual lives of women with TNBC, which can assist with guiding the formation of appropriate social work interventions.


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