Department of Population Health Sciences, Medical College of Georgia, Augusta University, 1120 15th Street, Augusta, GA, 30912, USA.
Institute of Public and Preventive Health, Augusta University, Augusta, GA, USA.
Breast Cancer Res Treat. 2019 Oct;177(3):537-548. doi: 10.1007/s10549-019-05340-7. Epub 2019 Jul 3.
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.
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.
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.
与乳腺癌发病率、诊断时的分期和生存相关的健康社会决定因素包括社会经济地位（收入、教育）、邻里劣势、失业、种族歧视、社会支持和社交网络。其他健康社会决定因素包括医疗不信任、移民地位、住房不足、食品安全和地理位置（如社区获得医疗服务的机会）等。社会经济因素会影响乳腺癌的风险。对于所有种族/族裔群体，乳腺癌发病率往往与社会经济地位呈正相关。另一方面，低社会经济地位与侵袭性绝经前乳腺癌风险增加、诊断时较晚分期以及生存状况较差有关。社会经济地位、种族、教育、普查区贫困程度以及获得健康保险和预防保健的情况等因素与乳腺癌生存状况存在明显差异。贫困与其他与乳腺癌诊断时较晚分期和生存状况较差相关的因素有关，例如医疗保险不足、缺乏初级保健医生以及获得医疗保健的机会有限。
本综述的结果表明，贫困、教育程度低、邻里劣势、按种族隔离居住、种族歧视、缺乏社会支持和社会孤立等社会决定因素在乳腺癌诊断时的分期和生存中起着重要作用。
为了解决这些社会决定因素并消除癌症差异，需要采取有效的干预措施，考虑到癌症患者生活和接受治疗的社会和环境背景。
