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Breast Cancer Research and Treatment

, Volume 177, Issue 3, pp 537–548 | Cite as

Social determinants of breast cancer risk, stage, and survival

  • Steven S. CoughlinEmail author
Review
  • 550 Downloads

Abstract

Purpose

Social determinants of health that have been examined in relation to breast cancer incidence, stage at diagnosis, and survival include socioeconomic status (income, education), neighborhood disadvantage, unemployment, racial discrimination, social support, and social network. Other social determinants of health include medical distrust, immigration, status, inadequate housing, food insecurity, and geographic factors such as neighborhood access to health services. Socioeconomic factors influence risk of breast cancer. For all racial/ethnic groups, breast cancer incidence rates tend to be positively associated with socioeconomic status. On the other hand, low socioeconomic status is associated with increased risk of aggressive premenopausal breast cancers as well as late stage of diagnosis and poorer survival. There are well-documented disparities in breast cancer survival by socioeconomic status, race, education, census-tract-level poverty, and access to health insurance and preventive care. Poverty is associated with other factors related to late stage at breast cancer diagnosis and poorer survival such as inadequate health insurance, lack of a primary care physician and poor access to health care.

Results

The results of this review indicate that social determinants such as poverty, lack of education, neighborhood disadvantage, residential segregation by race, racial discrimination, lack of social support, and social isolation play an important role in breast cancer stage at diagnosis and survival.

Conclusion

To address these social determinants and eliminate cancer disparities, effective interventions are needed that account for the social and environmental contexts in which cancer patients live and are treated.

Keywords

African Americans Education Food Insecurity Poverty Unemployment 

Notes

Compliance with ethical standards

Conflict of interest

The author declares he has no conflicts of interest.

Ethical approval

This article does not contain any studies with human participants performed by the author.

Informed consent

Not applicable.

References

  1. 1.
    Garg A, Jack B, Zuckerman B (2013) Addressing the social determinants of health within the patient-centered medical home. Lessons from pediatrics. JAMA 309:2001–2002CrossRefPubMedGoogle Scholar
  2. 2.
    World Health Organization (2014) World conference on social determinants of health: case studies on social determinants. http://www.who.int/sdhconference/resources/case_studies/en/
  3. 3.
    Institute of Medicine (US) (2003) Committee on assuring the health of the public in the 21st century. The future of the public’s health in the 21st century. National Academy Press, Washington, DCGoogle Scholar
  4. 4.
    Rogers RG, Hummer RA, Nam CB et al (1996) Demographic, socioeconomic, and behavioral factors affecting ethnic mortality by cause. Soc Forces 74:1419–1438CrossRefGoogle Scholar
  5. 5.
    Dana RH (1993) Multicultural assessment perspectives for professional psychology. Simon & Schuster, BostonGoogle Scholar
  6. 6.
    Baum A, Garofalo JP, Yali AM (1999) Socioeconomic status and chronic stress: does stress account for SES effects on health? Ann N Y Acad Sci 896:131–144CrossRefPubMedGoogle Scholar
  7. 7.
    Anderson NB, Armstead CA (1995) Toward understanding the association of socioeconomic status and health: a new challenge for the biopsychosocial approach. Psychosom Med 57:213–225CrossRefPubMedGoogle Scholar
  8. 8.
    Lantz PM, House JS, Lepkowski JM et al (1998) Socioeconomic factors, health behaviors, and mortality: results from a nationally representative prospective study of US adults. JAMA 279:1703–1708CrossRefPubMedGoogle Scholar
  9. 9.
    Rozanski A, Blumenthal JA, Davidson KW et al (2005) The epidemiology, pathophysiology, and management of psychosocial risk factors in cardiac practice: the emerging field of behavioral cardiology. J Am Coll Cardiol 45:637–651CrossRefPubMedGoogle Scholar
  10. 10.
    Pampel FC, Krueger PM, Denney JT (2010) Socioeconomic disparities in health behaviors. Ann Rev Sociol 36:349–370CrossRefGoogle Scholar
  11. 11.
    Rozanski A, Blumenthal JA, Kaplan J (1999) Impact of psychological factors on the pathogenesis of cardiovascular disease and implications for therapy. Circulation 1999(99):2192–2217CrossRefGoogle Scholar
  12. 12.
    García-León MÁ, Pérez-Mármol JM, Gonzalez-Perez R et al (2019) Relationship between resilience and stress: perceived stress, stressful life events, HPA axis response during a stressful task and hair cortisol. Physiol Behav 202:87–93CrossRefPubMedGoogle Scholar
  13. 13.
    Mohseny M, Amanpour F, Mosavi-Jarrahi A et al (2016) Application of Cox and parametric survival methods to assess social determinants of health affecting three-year survival of breast cancer patients. Asian Pac J Cancer Prev 17:311–316CrossRefPubMedGoogle Scholar
  14. 14.
    Dean LT, Gehlert S, Neuhouser ML et al (2018) Social factors matter in cancer risk and survivorship. Cancer Causes Control 29:611–618CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Dean LT, Mos SL, McCarthy AM et al (2017) Healthcare system distrust, physician distrust, and patient discordance with adjuvant breast cancer treatment recommendations. Cancer Epidemiol Prev Biomark 26:1745–1752CrossRefGoogle Scholar
  16. 16.
    Keegan TH, Quach T, Shema S et al (2010) The influence of nativity and neighborhoods on breast cancer stage at diagnosis and survival among California Hispanic women. BMC Cancer 10:603CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Gomez SL, Clarke CA, Shema SJ et al (2010) Disparities in breast cancer survival among Asian women by ethnicity and immigrant status: a population-based study. Am J Public Health 100:861–869CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Gomez SL, Quach T, Horn-Ross PL et al (2010) Hidden breast cancer disparities in Asian women: disaggregating incidence rates by ethnicity and migrant status. Am J Public Health 100:S125–S131CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Singh GK, Daus GP, Allender M et al (2017) Social determinants of health in the United States: addressing major health inequality trends for the Nation, 1935–2016. Int J MCH AIDS 6:139–164CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Noonan AS, Velasco-Mondragon HE, Wagner FA (2016) Improving the health of African Americans in the USA: an overdue opportunity for social justice. Public Health Rev 37:12–37CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Kawachi I, Kennedy B, Wilkinson RG (1999) Income inequality and health: a reader. New Press, New YorkGoogle Scholar
  22. 22.
    Daniels N, Kennedy B, Kawachi I (2000) Justice is good fr our health: how greater economic equality would promote public health. Boston Rev 25:4–19Google Scholar
  23. 23.
    Murthy VH (2016) Food insecurity: a public health issue. Public Health Rep 13:655–657Google Scholar
  24. 24.
    US Department of Agriculture, Economic Research Service. Definitions of food security http://www.ers.usda.gov/topics/food-nutiriton-assistance/food-security-in-the-us/definitions-of-food-security.aspx
  25. 25.
    Franklin B, Jones A, Love D et al (2012) Exploring mediators of food insecurity and obesity: a review of recent literature. J Community Health 37:253–264CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Seligman HK, Schillinger D (2010) Hunger and socioeconomic disparities in chronic disease. N Engl J Med 363:6–9CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Bruening M, Dinour LM, Rosales Chavez JB (2017) Food insecurity and emotional health in the USA: a systematic narrative review of longitudinal research. Public Health Nutr 20:3200–3208CrossRefPubMedGoogle Scholar
  28. 28.
    Kohler BA, Sherman RL, Howlader N et al (2015) Annual report to the nation on the status of cancer, 1975–2011, featuring incidence of breast cancer subtypes by race/ethnicity, poverty, and state. J Natl Cancer Inst 107:djv048CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Williams DR, Ammed SA, Shields AE (2016) Understanding and effectively addressing breast cancer in African American women: unpacking the social context. Cancer 122:2138–2149CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Yin D, Morris C, Allen M et al (2012) Does socioeconomic disparity in cancer incidence vary across racial/ethnic groups? Cancer Causes Control 23:951–958CrossRefGoogle Scholar
  31. 31.
    Dunn BK, Agurs-Collins T, Browne D et al (2010) Health disparities in breast cancer: biology meets socioeconomic status. Breast Cancer Res Treat 121:281–292CrossRefPubMedGoogle Scholar
  32. 32.
    Andaya AA, Enewold L, Horner MJ et al (2012) Socioeconomic disparities and breast cancer hormone receptor status. Cancer Causes Control 23:951–958CrossRefPubMedGoogle Scholar
  33. 33.
    Dayal HH, Power RN, Chiu C (1982) Race and socioeconomic status in survival from breast cancer. J Chronic Dis 35:675–683CrossRefPubMedGoogle Scholar
  34. 34.
    Herndon JE, Kornblith AB, Holland JC et al (2013) Effect of socioeconomic status as measured by education level on survival in breast cancer clinical trials. Psycho-Oncology 22:315–323PubMedGoogle Scholar
  35. 35.
    Singh GK, Miller BA, Hankey BF et al (2003) Area socioeconomic variations in U.S. cancer incidence, mortality, stage, treatment, and survival, 1975–1999. NCI cancer surveillance monograph series, vol 4. National Cancer Institute, BethesdaGoogle Scholar
  36. 36.
    Ward E, Halpern M, Schrag N et al (2008) Association of insurance with cancer care utilization and outcomes. CA Cancer J Clin 58:9–31CrossRefPubMedGoogle Scholar
  37. 37.
    Ayanian JZ, Kohler BA, Abe T et al (1993) The relation between health insurance coverage and clinical outcomes among women with breast cancer. N Engl J Med 329:326–331CrossRefPubMedGoogle Scholar
  38. 38.
    Roetzheim RG, Gonzalez EC, Ferrante JM et al (2000) Effects of health insurance and race on breast carcinoma treatments and outcomes. Cancer 89:2202–2213CrossRefPubMedGoogle Scholar
  39. 39.
    Silber JH, Rosenbaum PR, Ross RN et al (2018) Disparities in breast cancer survival by socioeconomic status despite Medicare and Medicaid insurance. Milbank Q 96:706–754CrossRefPubMedGoogle Scholar
  40. 40.
    Krieger N (2001) A glossary for social epidemiology. J Epidemiol Commun Health 55:693–700CrossRefGoogle Scholar
  41. 41.
    Shariff-Marco S, Yang J, John EM et al (2014) Impact of neighborhood and individual socioeconomic status on survival after breast cancer varies by race/ethnicity: the Neighborhood and Breast Cancer Study. Cancer Epidemiol Biomark Prev 23:793–811CrossRefGoogle Scholar
  42. 42.
    Kish JK, Yu M, Percy-Laurry A et al (2014) Racial and ethnic disparities in cancer survival by neighborhood socioeconomic status in surveillance, epidemiology, and end results (SEER) registries. J Natl Cancer Inst Monogr 49:236–243CrossRefGoogle Scholar
  43. 43.
    Feinglass J, Rydzewski N, Yang A (2015) The socioeconomic gradient in all-cauase mortality for women with breast cancer: findings from the 1998 to 2006 National Cancer Data Base with follow-up through 2011. Ann Epidemiol 25:549–555CrossRefPubMedGoogle Scholar
  44. 44.
    Conroy SM, Shariff-Marco S, Koo J et al (2017) Racial/ethnic differences in the impact of neighborhood social and build environment on breast cancer risk: the Neighborhoods and Breast Cancer Study. Cancer Epidemiol Biomark Prev 26:541–552CrossRefGoogle Scholar
  45. 45.
    Russell EF, Kramer MR, Cooper HLF et al (2012) Metropolitan area racial residential segregation, neighborhood racial composition, and breast cancer mortality. Cancer Causes Control 23:1519–1527CrossRefPubMedGoogle Scholar
  46. 46.
    Warner ET, Gomez SL (2010) Impact of neighborhood racial composition and metropolitan residential segregation on disparities in breast cancer stage at diagnosis and survival between black and white women in California. J Community Health 35:398–408CrossRefPubMedPubMedCentralGoogle Scholar
  47. 47.
    Haas JS, Earle CC, Orav JE et al (2008) Racial segregation and disparities in cancer stage for seniors. J Gen Intern Med 23:699–705CrossRefPubMedPubMedCentralGoogle Scholar
  48. 48.
    Russell E, Kramer MR, Cooper HLF et al (2011) Residential racial composition, spatial access to care, and breast cancer mortality among women in Georgia. J Urban Health 88:1117–1129CrossRefPubMedPubMedCentralGoogle Scholar
  49. 49.
    Pruitt SL, Lee SC, Tiro JA et al (2015) Residential racial segregation and mortality among Black, white, and Hispanic urban breast cancer patients in Texas, 1995–2009. Cancer 121:1845–1855CrossRefPubMedPubMedCentralGoogle Scholar
  50. 50.
    Pruitt SL, Tiro JA, Xuan L et al (2016) Hispanic and immigrant paradoxes in U.S. breast cancer mortality: impact of neighborhood poverty and Hispanic density. Int J Environ Res Public Health 13:1238CrossRefPubMedCentralGoogle Scholar
  51. 51.
    Hossain F, Danos D, Prakash O et al (2019) Neighborhood social determinants of triple negative breast cancer. Front Public Health 7:1–7CrossRefGoogle Scholar
  52. 52.
    Akinyemiju TF, Pisu M, Waterbor JW et al (2015) Socioeconomic status and incidence of breast cancer by hormone receptor subtype. SpringerPlus 4:508CrossRefPubMedPubMedCentralGoogle Scholar
  53. 53.
    Sineshaw HM, Gaudet M, Ward EM et al (2014) Association of race/ethnicity, socioeconomic status, and breast cancer subtypes in the National Cancer Data Base (2010–2011). Breast Cancer Res Treat 145:753–763CrossRefPubMedGoogle Scholar
  54. 54.
    Jones CP (2000) Levels of racism: a theoretic framework and a gardener’s tale. Am J Public Health 90:1212–1215CrossRefPubMedPubMedCentralGoogle Scholar
  55. 55.
    Beyer KMM, Zhou Y, Matthews K et al (2016) New spatially continuous indices of redlining and racial bias in mortgage lending: links to survival after breast cancer diagnosis and implications for health disparities research. Health Place 40:34–43CrossRefPubMedGoogle Scholar
  56. 56.
    Shariff-Marco S, Klassen AC, Bowie JV (2010) Racial/ethnic differences in self-reported racism and its association with cancer-related health behaviors. Am J Public Health 100:364–374CrossRefPubMedPubMedCentralGoogle Scholar
  57. 57.
    Taylor TR, Williams CD, Makambi KH et al (2007) Racial discrimination and breast cancer incidence in US Black women. The Black Women’s Health Study. Am J Epidemiol 166:46–54CrossRefPubMedGoogle Scholar
  58. 58.
    Ziegler RG, Hoover RN, Pike MC et al (1993) Migration patterns and breast cancer risk in Asian-American women. J Natl Cancer Inst 85:1819–1827CrossRefPubMedGoogle Scholar
  59. 59.
    Keegan THM, John EM, Fish KM et al (2010) Breast cancer incidence patterns among California Hispanic women: differences by nativity and residence in an enclave. Cancer Epidemiol Biomark Prev 19:1208–1218CrossRefGoogle Scholar
  60. 60.
    Schuldiner J, Liu Y, Lofters A (2018) Incidence of breast and colorectal cancer among immigrants in Ontario, Canada: a retrospective cohort study from 2004–2014. BMC Cancer 18:537CrossRefGoogle Scholar
  61. 61.
    Chakraborty S, Smith L, Ganti AK et al (2014) Breast cancer survival of Hispanic women in the USA is influenced by country of origin. Asia Pac J Clin Oncol 10:124–132CrossRefPubMedGoogle Scholar
  62. 62.
    Morey BN, Gee GC, von Ehrenstein OS et al (2019) Higher breast cancer risk among immigrant Asian American women than among US-born Asian American women. Prev Chronic Dis 16:E20CrossRefPubMedPubMedCentralGoogle Scholar
  63. 63.
    Camacho-Rivera M, Kalwar T, Sanmugarajah J et al (2014) Heterogeneity of breast cancer clinical characteristics and outcome in US Black women—effect of place of birth. Breast J 20(5):489–495CrossRefPubMedGoogle Scholar
  64. 64.
    Iqbal J, Ginsburg O, Fischer HD et al (2017) A population-based cross-sectional study comparing breast cancer stage at diagnosis between immigrant and Canadian-born women in Ontario. Breast J 23:525–536CrossRefPubMedGoogle Scholar
  65. 65.
    McDonald JT, Farnworth M, Liu Z (2017) Cancer and the healthy immigrant effect: a statistical analysis of cancer diagnosis using a linked Census-cancer registry administrative database. BMC Public Health 17:296CrossRefPubMedPubMedCentralGoogle Scholar
  66. 66.
    Graells-Sans A, Serral G, Puigpinos-Riera R et al (2018) Social inequalities in quality of life in a cohort of women diagnosed with breast cancer in Bercelona (DAMA Cohort). Cancer Epidemiol 54:38–47CrossRefPubMedGoogle Scholar
  67. 67.
    Chou AF, Stewart SL, Wild RC et al (2012) Social support and survival in young women with breast carcinoma. Psychooncology 21:125–133CrossRefPubMedGoogle Scholar
  68. 68.
    Aizer AA, Chen M-H, McCarthy EP et al (2013) Marital status and survival in patients with cancer. J Clin Oncol 31:3869–3876CrossRefPubMedPubMedCentralGoogle Scholar
  69. 69.
    Parise C, Caggiano V (2018) The influence of marital status and race/ethnicity on risk of mortality for triple negative breast cancer. PLoS ONE 13:e0196134CrossRefPubMedPubMedCentralGoogle Scholar
  70. 70.
    Goodwin J, Hunt W, Key C et al (1987) The effect of marital status on stage, treatment, and survival of cancer patients. JAMA 258:3120–3125CrossRefGoogle Scholar
  71. 71.
    Marchand L, Kolonel LN, Nomura A (1984) Relationship of ethnicity and other prognostic factors to breast cancer survival patterns in Hawaii. J Natl Cancer Inst 73:1259–1265Google Scholar
  72. 72.
    Funch D, Marshall J (1983) The role of stress, social support and age in survival from breast cancer. J Psychosom Res 27:77–83CrossRefPubMedGoogle Scholar
  73. 73.
    Bélanger E, Ahmed T, Vafaei A et al (2016) Sources of social support associated with health and quality of life: a cross-sectional study among Canadian and Latin American older adults. BMJ Open 6:e011503CrossRefPubMedPubMedCentralGoogle Scholar
  74. 74.
    Walker RJ, Gebregziabher M, Martin-Harris B et al (2014) Relationship between social determinants of health and processes and outcomes in adults with type 2 diabetes: validation of a conceptual framework. BMC Endocr Disord 14:82CrossRefPubMedPubMedCentralGoogle Scholar
  75. 75.
    Gage-Bouchard EA (2017) Social support, flexible resources, and health care navigation. Soc Sci Med 190:111–118CrossRefPubMedPubMedCentralGoogle Scholar
  76. 76.
    Kroenke CH, Kubzansky LD, Schernhammer ES et al (2006) Social networks, social support, and survival after breast cancer diagnosis. J Clin Oncol 24:1105–1111CrossRefPubMedGoogle Scholar
  77. 77.
    Kroenke CH, Michael Y, Tindle H et al (2012) Social networks, social support and burden in relationships, and mortality after breast cancer diagnosis. Breast Cancer Res Treat 133:375–385CrossRefPubMedPubMedCentralGoogle Scholar
  78. 78.
    Kroenke CH, Quesenberry C, Kwan ML et al (2013) Social networks, social support, and burden in relationships, and mortality after breast cancer diagnosis in the life after breast cancer epidemiology (LACE) study. Breast Cancer Res Treat 137:261–271CrossRefPubMedGoogle Scholar
  79. 79.
    Kroenke CH, Michael YL, Poole EM et al (2017) Post-diagnosis social networks and breast cancer mortality in the after breast cancer pooling project (ABCPP). Cancer 123:1228–1237CrossRefPubMedGoogle Scholar
  80. 80.
    Reynolds P, Boyd PT, Blacklow RS et al (1994) The relationship between social ties and survival among Black and white breast cancer patients. Cancer Epidemiol Biomark Prev 3:253–259Google Scholar
  81. 81.
    Roseland ME, Schwartz K, Ruterbusch JJ et al (2017) Influence of clinical, societal, and treatment variables on racial differences in ER-/PR- breast cancer survival. Breast Cancer Res Treat 165:163–168CrossRefPubMedGoogle Scholar
  82. 82.
    Dietze EC, Sistrunk C, Miranda-Carboni G et al (2015) Triple-negative breast cancer in African-American women: disparities versus biology. Nat Rev Cancer 15:248–254CrossRefPubMedPubMedCentralGoogle Scholar
  83. 83.
    Greenfield EA, Marks NF (2009) Violence from parents in childhood and obesity in adulthood: using food in response to stress as a mediator of risk. Soc Sci Med 68:791–798CrossRefPubMedPubMedCentralGoogle Scholar

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© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Population Health Sciences, Medical College of GeorgiaAugusta UniversityAugustaUSA
  2. 2.Institute of Public and Preventive HealthAugusta UniversityAugustaUSA

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