Skip to main content

Advertisement

SpringerLink
Log in

The Impact of Socioeconomic Status and Social Determinants of Health on Disparities in Breast Cancer Incidence, Treatment, and Outcomes

  • Published:
Current Breast Cancer Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Differences in socioeconomic status (SES) and social determinants of health (SDH) account for many of the disparities seen among patients diagnosed with breast cancer. This review outlines how low SES/SDH factors impact patients along the continuum of breast cancer care from screening to survivorship.

Recent Findings

Factors such as place of residence, race, income, insurance status, and social networks all strongly correlate with the degree to which patients have access to and utilize breast cancer screening, their composite treatment once diagnosed, the financial impact of treatment, and ultimately, their disease and survival outcomes. The increased complexity of community and social networks creates difficulty in understanding the interplay of SES/SDH factors and breast cancer outcomes and has provided challenges in targeted interventions to reduce disparities.

Summary

Recent research has underscored that non-biologic SES/SDH factors have important and sizable impacts on breast cancer care. Targeted efforts to address these disparities must respond to a dynamic and complex interplay between biologic and SES/SDH factors. Providing high-quality, guideline-concordant, multidisciplinary care to all patients regardless of social factors remains the most important strategy across all healthcare settings.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Siegel RL, Miller KD, Fuchs HE, Jemal A. Cancer statistics, 2022. CA Cancer J Clin. 2022;72:7–33.

    Article  PubMed  Google Scholar 

  2. Thompson B, Hohl SD, Molina Y, Paskett ED, Fisher JL, Baltic RD, Washington CM. Breast cancer disparities among women in underserved communities in the USA. Curr Breast Cancer Rep. 2018;10:131–41.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Baker EH (2014) Socioeconomic status, definition. Wiley Blackwell Encycl Heal Illness, Behav Soc 2210–2214

  4. Census Tract-level SES and Rurality Database - SEER*Stat. https://seer.cancer.gov/seerstat/databases/census-tract/index.html. Accessed 23 Apr 2022

  5. Yost K, Perkins C, Cohen R, Morris C, Wright W. Socioeconomic status and breast cancer incidence in California for different race/ethnic groups. Cancer Causes Control. 2001;12:703–11.

    Article  CAS  PubMed  Google Scholar 

  6. Social Determinants of Health - Healthy People 2030 | health.gov. https://health.gov/healthypeople/priority-areas/social-determinants-health. Accessed 22 Apr 2022

  7. Logie C. The case for the World Health Organization’s Commission on the social determinants of health to address sexual orientation. Am J Public Health. 2012;102:1243.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Williams SL, Mann AK. Sexual and gender minority health disparities as a social issue: how stigma and intergroup relations can explain and reduce health disparities. J Soc Issues. 2017;73:450–61.

    Article  Google Scholar 

  9. Matthews AK, Breen E, Kittiteerasack P. Social determinants of LGBT cancer health inequities. Semin Oncol Nurs. 2018. https://doi.org/10.1016/j.soncn.2017.11.001.

    Article  PubMed  Google Scholar 

  10. Duffy SW, Tabár L, Yen AMF, et al. Mammography screening reduces rates of advanced and fatal breast cancers: results in 549,091 women. Cancer. 2020;126:2971–9.

    Article  PubMed  Google Scholar 

  11. Duffy SW, Tabár L, Yen AMF, et al. Beneficial effect of consecutive screening mammography examinations on mortality from breast cancer: a prospective study. Radiology. 2021;299:541–7.

    Article  PubMed  Google Scholar 

  12. •• Herbert C, Paro A, Diaz A, Pawlik TM. Association of community economic distress and breast and colorectal cancer screening, incidence, and mortality rates among US counties. Ann Surg Oncol. 2022;29:837–48. In an analysis of three national data sets, stratifying patients by county-level Distressed Community Index, patients who live in the most distressed counties had lower levels of breast cancer screening, higher rates of breast cancer mortality, and lower decrease in mortality over five years than women living in less distressed counties.

    Article  PubMed  Google Scholar 

  13. Elkin EB, Ishill NM, Snow JG, Panageas KS, Bach PB, Liberman L, Wang F, Schrag D. Geographic access and the use of screening mammography. Med Care. 2010;48:349–56.

    Article  PubMed  PubMed Central  Google Scholar 

  14. • Lee CI, Zhu W, Onega T, et al. Comparative access to and use of digital breast tomosynthesis screening by women’s race/ethnicity and socioeconomic status. JAMA Netw Open. 2021;4:e2037546–e2037546. In this large-scale, cross-sectional analysis women with low socioeconomic status and minority race underwent tomosynthesis at lower rates.

    Article  PubMed  PubMed Central  Google Scholar 

  15. • Williams AD, Bleicher RJ, Ciocca RM. Breast cancer risk, screening, and prevalence among sexual minority women: an analysis of the National Health Interview Survey. LGBT Heal. 2020;7:109–18. Sexual minority women (SMW)reported higher rates of breast cancer risk factors in the National Health Interview Survey. Despite reporting similar rates of mammography, SMW had higher rates of diagnostic imaging than non-SMW.)

    Article  Google Scholar 

  16. Cragun D, Bonner D, Kim J, Akbari MR, Narod SA, Gomez-Fuego A, Garcia JD, Vadaparampil ST, Pal T. Factors associated with genetic counseling and BRCA testing in a population-based sample of young Black women with breast cancer. Breast Cancer Res Treat. 2015;151:169.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Jones T, mccarthy AM, Kim Y, Armstrong K. Predictors of BRCA1/2 genetic testing among Black women with breast cancer: a population-based study. Cancer Med. 2017;6:1787–98.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Chapman-Davis E, Zhou ZN, Fields JC, Frey MK, Jordan B, Sapra KJ, Chatterjee-Paer S, Carlson AD, Holcomb KM. Racial and ethnic disparities in genetic testing at a hereditary breast and ovarian cancer center. J Gen Intern Med. 2021;36:35–42.

    Article  PubMed  Google Scholar 

  19. Baptiste DF, macgeorge EL, Venetis MK, Mouton A, Friley LB, Pastor R, Hatten K, Lagoo J, Clare SE, Bowling MW. Motivations for contralateral prophylactic mastectomy as a function of socioeconomic status. BMC Womens Health. 2017;17:1–9.

    Article  Google Scholar 

  20. Henry DA, Lee MC, Almanza D, Ahmed KA, Sun W, Boulware DC, Laronga C. Trends in use of bilateral prophylactic mastectomy vs high-risk surveillance in unaffected carriers of inherited breast cancer syndromes in the Inherited Cancer Registry (ICARE). Breast Cancer Res Treat. 2019;174:39–45.

    Article  CAS  PubMed  Google Scholar 

  21. Padamsee TJ, Hils M, Muraveva A. Understanding low chemoprevention uptake by women at high risk of breast cancer: findings from a qualitative inductive study of women’s risk-reduction experiences. BMC Womens Health. 2021;21:1–12.

    Google Scholar 

  22. Obeng-Gyasi S, Timsina L, Bhattacharyya O, Fisher CS, Haggstrom DA. Breast cancer presentation, surgical management and mortality across the rural–urban continuum in the National Cancer Database. Ann Surg Oncol. 2020;27:1805–15.

    Article  PubMed  Google Scholar 

  23. Akinyemiju T, Moore JX, Ojesina AI, Waterbor JW, Altekruse SF. Racial disparities in individual breast cancer outcomes by hormone-receptor subtype, area-level socio-economic status and healthcare resources. Breast Cancer Res Treat. 2016;157:575–86.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Williams F, Jeanetta S, James AS. Geographical location and stage of breast cancer diagnosis: a systematic review of the literature. J Health Care Poor Underserved. 2016;27:1357–83.

    Article  PubMed  Google Scholar 

  25. Desantis CE, Ma J, Goding Sauer A, Newman LA, Jemal A. Breast cancer statistics, 2017, racial disparity in mortality by state. CA Cancer J Clin. 2017;67:439–48.

    Article  PubMed  Google Scholar 

  26. Williams AD, Buckley M, Ciocca RM, Sabol JL, Larson SL, Carp NZ. Racial and socioeconomic disparities in breast cancer diagnosis and mortality in Pennsylvania. Breast Cancer Res Treat. 2022;192:191–200.

    Article  PubMed  Google Scholar 

  27. American Cancer Society Cancer Facts & Figures for African Americans 2019–2021. https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/cancer-facts-and-figures-for-african-americans/cancer-facts-and-figures-for-african-americans-2019-2021.pdf. Accessed 23 Apr 2022.

  28. Pellom ST, Arnold T, Williams M, Brown VL, Samuels AD. Examining breast cancer disparities in African Americans with suggestions for policy. Cancer Causes Control. 2020;31:795–800.

    Article  PubMed  Google Scholar 

  29. Stead LA, Lash TL, Sobieraj JE, Chi DD, Westrup JL, Charlot M, Blanchard RA, Lee JC, King TC, Rosenberg CL. Triple-negative breast cancers are increased in black women regardless of age or body mass index. Breast Cancer Res. 2009;11:1–10.

    Article  Google Scholar 

  30. Linnenbringer E, Geronimus AT, Davis KL, et al. Associations between breast cancer subtype and neighborhood socioeconomic and racial composition among Black and White women. Breast Cancer Res Treat. 2020;180:437–47.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Qin B, Babel RA, Plascak JJ, et al. Neighborhood social environmental factors and breast cancer subtypes among Black women. Cancer Epidemiol Biomarkers Prev. 2021;30:344–50.

    Article  CAS  PubMed  Google Scholar 

  32. Woods LM, Rachet B, Coleman MP. Origins of socio-economic inequalities in cancer survival: a review. Ann Oncol. 2006;17:5–19.

    Article  CAS  PubMed  Google Scholar 

  33. Halpern MT, Bian J, Ward EM, Schrag NM, Chen AY. Insurance status and stage of cancer at diagnosis among women with breast cancer. Cancer. 2007;110:403–11.

    Article  PubMed  Google Scholar 

  34. Ko NY, Hong S, Winn RA, Calip GS, et al. Association of insurance status and racial disparities with the detection of early-stage breast cancer. JAMA Oncol. 2020;6:385–92.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Camacho-Rivera M, Kalwar T, Sanmugarajah J, Shapira I, Taioli E. Heterogeneity of breast cancer clinical characteristics and outcome in US Black women—effect of place of birth. Breast J. 2014;20:489–95.

    Article  PubMed  Google Scholar 

  36. Iqbal J, Ginsburg O, Fischer HD, Austin PC, Creatore MI, Narod SA, Rochon PA. A population-based cross-sectional study comparing breast cancer stage at diagnosis between immigrant and Canadian-born women in Ontario. Breast J. 2017;23:525–36.

    Article  PubMed  Google Scholar 

  37. Morey BN, Gee GC, von Ehrenstein OS, et al. Higher breast cancer risk among immigrant Asian American women than among US-born Asian American women. Prev Chronic Dis. 2019. https://doi.org/10.5888/PCD16.180221.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Reynolds P, Boyd P, Blacklow R, Jackson J, Greenberg R, Austin D, Chen V, Edwards B. The relationship between social ties and survival among black and white breast cancer patients. National Cancer Institute Black/White Cancer Survival Study Group - pubmed. Cancer Epidemiol Biomarkers Prev. 1994;3:253–9.

    CAS  PubMed  Google Scholar 

  39. Lautner M, Lin H, Shen Y, Parker C, Kuerer H, Shaitelman S, Babiera G, Bedrosian I. Disparities in the use of breast-conserving therapy among patients with early-stage breast cancer. JAMA Surg. 2015;150:778–86.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Parekh A, Fu W, Hu C, Shen CJ, Alcorn S, Rao AD, Asrari F, Camp MS, Wright JL. Impact of race, ethnicity, and socioeconomic factors on receipt of radiation after breast conservation surgery: analysis of the national cancer database. Breast Cancer Res Treat. 2018;172:201–8.

    Article  PubMed  Google Scholar 

  41. Butler PD, Familusi O, Serletti JM, Fox JP. Influence of race, insurance status, and geographic access to plastic surgeons on immediate breast reconstruction rates. Am J Surg. 2018;215:987–94.

    Article  PubMed  Google Scholar 

  42. Decoster RC, Bautista RMF, Burns JC, Dugan AJ, Edmunds RW, Rinker BD, Webster JM, Vasconez HC. Rural-urban differences in breast reconstruction utilization following oncologic resection. J Rural Health. 2020;36:347–54.

    Article  PubMed  Google Scholar 

  43. Bauder AR, Gross CP, Killelea BK, Butler PD, Kovach SJ, Fox JP. The relationship between geographic access to plastic surgeons and breast reconstruction rates among women undergoing mastectomy for cancer. Ann Plast Surg. 2017;78:324–9.

    Article  CAS  PubMed  Google Scholar 

  44. Neuner JM, Kong A, Blaes A, Riley D, Chrischilles E, Smallwood A, Lizarraga I, Schroeder M. The association of socioeconomic status with receipt of neoadjuvantchemotherapy. Breast Cancer Res Treat. 2019;173:179.

    Article  PubMed  Google Scholar 

  45. Dreyer MS, Nattinger AB, mcginley EL, Pezzin LE. Socioeconomic status and breast cancer treatment. Breast Cancer Res Treat. 2018;167:1–8.

    Article  PubMed  Google Scholar 

  46. Relation T, Obeng-Gyasi S, Bhattacharyya O, Li Y, Eskander MF, Tsung A, Oppong BA. Racial differences in response to neoadjuvant chemotherapy: impact on breast and axillary surgical management. Ann Surg Oncol. 2021;28:6489.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Wu XC, Lund MJ, Kimmick GG, et al. Influence of race, insurance, socioeconomic status, and hospital type on receipt of guideline-concordant adjuvant systemic therapy for locoregional breast cancers. J Clin Oncol. 2012;30:142–50.

    Article  PubMed  Google Scholar 

  48. •• Hoskins KF, Danciu OC, Ko NY, Calip GS. Association of race/ethnicity and the 21-gene recurrence score with breast cancer-specific mortality among US women. JAMA Oncol. 2021;7:370–8. In an analysis of the SEER database, Black women were more likely to have high-risk recurrence score and had higher rates of mortality than non-Hispanic White women with similar recurrence scores.

    Article  PubMed  Google Scholar 

  49. Lipscomb J, Gillespie TW, Goodman M, Richardson LC, Pollack LA, Ryerson AB, Ward KC. Black-white differences in receipt and completion of adjuvant chemotherapy among breast cancer patients in a rural region of the US. Breast Cancer Res Treat. 2012;133:285–96.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  50. • Sadigh G, Gray RJ, Sparano JA, Yanez B, Garcia SF, Timsina LR, Sledge GW, Cella D, Wagner LI, Carlos RC. Breast cancer patients’ insurance status and residence zip code correlate with early discontinuation of endocrine therapy: an analysis of the ECOG-ACRIN tailorx trial. Cancer. 2021;127:2545–52. Additional follow-up analyses of tailorx trial data demonstrate that socioeconomic features are associated with discontinuation of adjuvant endocrine therapy, which has implications for outcomes.

    Article  PubMed  Google Scholar 

  51. Abdel-Rahman O. Impact of NCI Socioeconomic index on the outcomes of nonmetastatic breast cancer patients: analysis of SEER Census tract-level socioeconomic database. Clin Breast Cancer. 2019;19:e717–22.

    Article  PubMed  Google Scholar 

  52. Moore JX, Royston KJ, Langston ME, Griffin R, Hidalgo B, Wang HE, Colditz G, Akinyemiju T. Mapping hot spots of breast cancer mortality in the United States: place matters for Blacks and Hispanics. Cancer Causes Control. 2018;29:737–50.

    Article  PubMed  PubMed Central  Google Scholar 

  53. Newman LA, Griffith KA, Jatoi I, Simon MS, Crowe JP, Colditz GA. Meta-analysis of survival in African American and white American patients with breast cancer: ethnicity compared with socioeconomic status. J Clin Oncol. 2006;24:1342–9.

    Article  PubMed  Google Scholar 

  54. Obeng-Gyasi S, Asad S, Fisher JL, Rahurkar S, Stover DG. Socioeconomic and surgical disparities are associated with rapid relapse in patients with triple-negative breast cancer. Ann Surg Oncol. 2021;28:6500–9.

    Article  PubMed  PubMed Central  Google Scholar 

  55. Tao L, Gomez SL, Keegan THM, Kurian AW, Clarke CA. Breast cancer mortality in African-American and non-Hispanic White women by molecular subtype and stage at diagnosis: a population-based study. Cancer Epidemiol Biomarkers Prev. 2015;24:1039–45.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  56. Jemal A, Robbins AS, Lin CC, Flanders WD, desantis CE, Ward EM, Freedman RA. Factors that contributed to Black-White disparities in survival among nonelderly women with breast cancer between 2004 and 2013. J Clin Oncol. 2018;36:14–24.

    Article  PubMed  Google Scholar 

  57. Singh GK, Jemal A. Socioeconomic and racial/ethnic disparities in cancer mortality, incidence, and survival in the United States, 1950–2014: over six decades of changing patterns and widening inequalities. J Environ Public Health. 2017;2017:1–19.

    Article  Google Scholar 

  58. Gooiker GA, Van Gijn W, Post PN, Van De Velde CJH, Tollenaar RAEM, Wouters MWJM. A systematic review and meta-analysis of the volume-outcome relationship in the surgical treatment of breast cancer Are breast cancer patients better of with a high volume provider. Eur J Surg Oncol. 2010;36(27):35. https://doi.org/10.1016/J.EJSO.2010.06.024.

    Article  Google Scholar 

  59. Kong AL, Pezzin LE, Nattinger AB. Identifying patterns of breast cancer care provided at high-volume hospitals: a classification and regression tree analysis. Breast Cancer Res Treat. 2015;153:689–98.

    Article  PubMed  Google Scholar 

  60. Collin LJ, Ross-Driscoll K, Nash R, et al. Time to surgical treatment and facility characteristics as potential drivers of racial disparities in breast cancer mortality. 2022;29:4728–4738.

  61. Williams AD, Ciocca R, Sabol JL, Carp NZ. Institutions treating breast cancer patients of a low socioeconomic status achieve multidisciplinary quality standards at lower rates. Ann Surg Oncol. 2021;28:5635–47.

    Article  PubMed  Google Scholar 

  62. Kantor O, Chang C, Yao K, et al. Uptake of breast cancer clinical trials at minority serving cancer centers. Ann Surg Oncol. 2021;28:4995–5004.

    Article  PubMed  Google Scholar 

  63. Song JH, Kantor O, Mittendorf EA, King TA, Minami CA. Race and site of care impact treatment delays in older women with non-metastatic breast cancer. Ann Surg Oncol. 2022. https://doi.org/10.1245/S10434-022-11543-Y.

    Article  PubMed  Google Scholar 

  64. Greenup RA, Rushing C, Fish L, et al. Financial costs and burden related to decisions for breast cancer surgery. J Oncol Pract. 2019;15:E666–76.

    Article  PubMed  PubMed Central  Google Scholar 

  65. Offodile AC, Asaad M, Boukovalas S, Bailey C, Lin YL, Teshome M, Greenup RA, Butler C. Financial toxicity following surgical treatment for breast cancer: a cross-sectional pilot study. Ann Surg Oncol. 2021;28:2451–62.

    Article  PubMed  Google Scholar 

  66. Corkum J, Zhu V, Agbafe V, Sun SX, Chu C, Colen JS, Greenup R, Offodile AC. Area deprivation index and rurality in relation to financial toxicity among breast cancer surgical patients: retrospective cross-sectional study of geospatial differences in risk profiles. J Am Coll Surg. 2022;234:816–26.

    Article  PubMed  Google Scholar 

  67. Politi MC, Yen RW, Elwyn G, O’Malley AJ, Saunders CH, Schubbe D, Forcino R, Durand MA. Women who are young, non-White, and with lower socioeconomic status report higher financial toxicity up to 1 year after breast cancer surgery: a mixed-effects regression analysis. Oncologist. 2021;26:e142–52.

    Article  PubMed  Google Scholar 

  68. Crown A, Ramiah K, Siegel B, Joseph K-A. The role of safety-net hospitals in reducing disparities in breast cancer care. Ann Surg Oncol. 2022. https://doi.org/10.1245/S10434-022-11576-3.

    Article  PubMed  Google Scholar 

  69. Mohan G, Chattopadhyay S. Cost-effectiveness of leveraging social determinants of health to improve breast, cervical, and colorectal cancer screening: a systematic review. JAMA Oncol. 2020;6:1434–44.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 300 E. 66thStreet, New York, NY, 10065, USA

    Austin D. Williams & Tracy-Ann Moo

Authors
  1. Austin D. Williams
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Tracy-Ann Moo
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Tracy-Ann Moo.

Ethics declarations

Conflict of Interest

The authors declare no competing interests.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Williams, A.D., Moo, TA. The Impact of Socioeconomic Status and Social Determinants of Health on Disparities in Breast Cancer Incidence, Treatment, and Outcomes. Curr Breast Cancer Rep 15, 30–36 (2023). https://doi.org/10.1007/s12609-023-00473-7

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12609-023-00473-7

Keywords

Search

Navigation