Impact of Structural Racism and Social Determinants of Health on Disparities in Breast Cancer Mortality.

Abstract

The striking ethnic and racial disparities in breast cancer mortality are not explained fully by pathologic or clinical features. Structural racism contributes to adverse conditions that promote cancer inequities, but the pathways by which this occurs are not fully understood.

Social determinants of health, such as economic status and access to care, account for a portion of this variability, yet interventions designed to mitigate these barriers have not consistently led to improved outcomes.

Based on the current evidence from multiple disciplines, we describe a conceptual model in which structural racism and racial discrimination contribute to increased mortality risk in diverse groups of patients by promoting adverse social determinants of health that elevate exposure to environmental hazards and stress; these exposures in turn contribute to epigenetic and immune dysregulation, thereby altering breast cancer outcomes.

Based on this model, opportunities and challenges arise for interventions to reduce racial and ethnic disparities in breast cancer mortality.

References:

Islami F, Baeker Bispo J, Lee H, Wiese D, Yabroff KR, Bandi P, et al. American Cancer Society’s report on the status of cancer disparities in the United States, 2023. CA Cancer J Clin 2023
Taparra K, Dee EC, Dao D, Patel R, Santos P, Chino F. Disaggregation of Asian American and Pacific Islander Women With Stage 0-II Breast Cancer Unmasks Disparities in Survival and Surgery-to-Radiation Intervals: A National Cancer Database Analysis From 2004 to 2017. JCO Oncol Pract 2022;18:e1255–e64
Lawson MB, Bissell MCS, Miglioretti DL, Eavey J, Chapman CH, Mandelblatt JS, et al. Multilevel Factors Associated With Time to Biopsy After Abnormal Screening Mammography Results by Race and Ethnicity. JAMA Oncol 2022;8:1115–26
Nguyen KH, Pasick RJ, Stewart SL, Kerlikowske K, Karliner LS. Disparities in abnormal mammogram follow-up time for Asian women compared with non-Hispanic white women and between Asian ethnic groups. Cancer 2017;123:3468–75
Lorona NC, Malone KE, Li CI. Racial/ethnic disparities in risk of breast cancer mortality by molecular subtype and stage at diagnosis. Breast Cancer Res Treat 2021;190:549–58

Article info

Journal issue:

Volume: 84
Issue: 23

Doi:

10.1158/0008-5472.CAN-24-1359

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Impact of Structural Racism and Social Determinants of Health on Disparities in Breast Cancer Mortality.

Abstract

Based on this model, opportunities and challenges arise for interventions to reduce racial and ethnic disparities in breast cancer mortality.

References:

Islami F, Baeker Bispo J, Lee H, Wiese D, Yabroff KR, Bandi P, et al. American Cancer Society’s report on the status of cancer disparities in the United States, 2023. CA Cancer J Clin 2023
Taparra K, Dee EC, Dao D, Patel R, Santos P, Chino F. Disaggregation of Asian American and Pacific Islander Women With Stage 0-II Breast Cancer Unmasks Disparities in Survival and Surgery-to-Radiation Intervals: A National Cancer Database Analysis From 2004 to 2017. JCO Oncol Pract 2022;18:e1255–e64
Lawson MB, Bissell MCS, Miglioretti DL, Eavey J, Chapman CH, Mandelblatt JS, et al. Multilevel Factors Associated With Time to Biopsy After Abnormal Screening Mammography Results by Race and Ethnicity. JAMA Oncol 2022;8:1115–26
Nguyen KH, Pasick RJ, Stewart SL, Kerlikowske K, Karliner LS. Disparities in abnormal mammogram follow-up time for Asian women compared with non-Hispanic white women and between Asian ethnic groups. Cancer 2017;123:3468–75
Lorona NC, Malone KE, Li CI. Racial/ethnic disparities in risk of breast cancer mortality by molecular subtype and stage at diagnosis. Breast Cancer Res Treat 2021;190:549–58