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Healthcare system distrust and the breast cancer continuum of care



To identify and synthesize the literature on healthcare system distrust across the breast cancer continuum of care.


We searched CINAHL, Cochrane, EMBASE, PubMed, PsycINFO, and Web of Science from January 1, 1990 to December 31, 2018 for all peer-reviewed publications addressing the role of healthcare system trust, distrust or mistrust in the breast cancer continuum of care.


We identified a total of 20 studies, seven qualitative studies and thirteen quantitative studies. Two studies assessed genetic testing, eleven assessed screening and seven assessed treatment and follow-up. Twelve studies evaluated mistrust, five evaluated distrust, and three evaluated trust. Study populations included African American, American Indian, Latina, Hispanic, and Asian American participants.


Healthcare system distrust is prevalent across many different racial and ethnic groups and operates across the entire breast cancer continuum of care. It is an important yet understudied barrier to cancer. We hope that the knowledge garnered by this study will enable researchers to form effective and targeted interventions to reduce healthcare system distrust mediated disparities in breast cancer outcomes.

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This work was supported by the National Cancer Institute Grant K01CA184288; the National Institute of Mental Health Grant R25MH083620; the Sidney Kimmel Cancer Center Grant P30CA006973, and the National Heart, Lung and Blood Institute Pharmacoepidemiology training Grant 1T32HL139426-1.

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Correspondence to Morgane C. Mouslim.

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Mouslim, M.C., Johnson, R.M. & Dean, L.T. Healthcare system distrust and the breast cancer continuum of care. Breast Cancer Res Treat 180, 33–44 (2020).

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  • Trust in healthcare system
  • Breast cancer prevention
  • Breast cancer treatment
  • Racial/ethnic disparities