**Background:** Black female breast cancer patients have the highest breast cancer mortality rates and shortest overall survival of any racial/ethnic group in the US. They are diagnosed at younger ages, with more advanced stages, and have higher prevalence of aggressive subtypes. Cardiovascular disease (CVD) is a significant competing cause of mortality, yet few studies have examined CVD risk factors specifically among Black breast cancer survivors. Prior work by the authors using Maryland Cancer Registry data found a 33% increased risk of CVD mortality among Black women compared to White women, with nearly 3-fold increased hazard among those aged 50-59 years. This pilot study aimed to describe the burden of obesity, comorbidity, and behavioral CVD risk factors among Black breast cancer survivors in Maryland using social media recruitment strategies.
**Methods:** This cross-sectional pilot study recruited 100 Black female breast cancer survivors in Maryland using social media (Facebook and Instagram advertisements) and survivor networks between January 5, 2022 and August 18, 2022. The Facebook ad reached 118,461 individuals, generating 2,650 link clicks, 3,539 post engagements, 611 post reactions, and 181 post shares. Eligible participants were biologically female, African American/Black, diagnosed with breast cancer (stages in situ-IV), and resided in Maryland. Participants completed an online REDCap survey covering demographics, clinical characteristics, health behaviors, and comorbidities. Physical activity was assessed using the CDC NHANES Physical Activity Questionnaire and evaluated against ACSM exercise recommendations (≥150 min/week moderate-intensity or ≥75 min/week vigorous-intensity aerobic activity on ≥3 days/week; strength training ≥2 days/week). Descriptive statistics were analyzed overall and by county (Baltimore City/Baltimore County, Prince George's County, Other).
**Key Results:** Mean age at survey was 58.6 years (SD=10.1) and at primary breast cancer diagnosis was 49.1 years (SD=10.2), with an average of 9.2 years (SD=8.4) between diagnosis and survey. Most women (70%) were diagnosed with stages I-IV breast cancer; 28% were diagnosed with in situ disease. Hypertension was the most prevalent comorbidity (51%), followed by arthritis (45%), lymphedema (32%), and self-reported obesity (32%). Notably, 28% reported ≥6 comorbid conditions. While only 7% reported being obese (BMI ≥30) at breast cancer diagnosis, 54% reported being obese at the time of survey. Mean current BMI was 31.7 (SD=6.95). Only 28% met ACSM weekly aerobic exercise recommendations, and 35% met strength training recommendations. Most women reported never smoking (70%) and consuming ≤1 alcoholic drink/day (95%). Among ever smokers (30%), most resided in Baltimore City/Baltimore County (n=18). Only 6 women reported current smoking. By county, Baltimore City/Baltimore County residents had the lowest prevalence of recent breast cancer screening (60.6%) compared to Prince George's County (87.9%) and Other counties (82.4%).
**Clinical Implications:** This pilot study identified a high burden of modifiable CVD risk factors among Black breast cancer survivors, particularly hypertension, post-diagnosis weight gain, and physical inactivity. The dramatic increase in obesity from 7% at diagnosis to 54% at survey (average 9 years later) underscores the need for weight management interventions during survivorship. The low proportion meeting exercise recommendations (28% aerobic, 35% strength training) represents a critical intervention target. These findings will inform a future statewide multilevel prospective study to improve health behaviors and disease management among Black breast cancer survivors at high risk of poor outcomes. Limitations include potential selection bias from social media recruitment (younger, higher income/education sample), healthy survivor bias (no participants reported CVD), and missing data for behavioral factors.