Akkala Sreelatha, Zuber Mohammed, Atta Julie Alaere, Mzizi Nompumelelo O, Akkula Jyothi
School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, USA.
College of Pharmacy, University of Georgia, Athens, GA, USA.
Cancer Control. 2025 Jan-Dec;32:10732748251341520. doi: 10.1177/10732748251341520. Epub 2025 May 9.
BackgroundIn 2024, breast cancer is the second most common cancer globally, affecting 2.3 million women. In the United States (US), 310 720 new female breast cancer cases were estimated in 2024. Existing research has identified substantial disparities in breast cancer treatment and survival based on socioeconomic status (SES). This systematic review examines the association between the key SES indicators income, education, and occupation on breast cancer outcomes among the US breast cancer patients.MethodsAn electronic search was conducted using Medline®, Embase®, and Web of Science, from inception to December 2023. Observational studies examining the influence of SES indicators on breast cancer outcomes, including treatment receipt, adherence, and survival, were included. Data were summarized qualitatively due to heterogeneity in SES measures and outcome definitions.ResultsOf 2600 studies retrieved from the searches, 23 studies met the inclusion criteria (19 cohort, 4 cross-sectional). Women with lower SES were less likely to receive or experience delay in receiving the recommended treatment than women with higher SES. In addition, women with low household income (<$25,000) were more likely to report discontinuations in therapy as compared to women with an income of $50,000 or more. Education level influenced treatment adherence and timely care, with higher educational attainment linked to improved survival rates. Occupational status impacted treatment continuity, with low-wage jobs and inflexible work schedules contributing to delays and discontinuation of care.ConclusionSES significantly influences breast cancer care and survival, with lower SES associated with delayed treatment, poorer adherence, and worse outcomes. Healthcare interventions and policies focusing on equitable access to quality care tailored to all women, regardless of their socioeconomic background, may improve breast cancer outcomes for the patients with various demographic characteristics in the US.
背景
2024年，乳腺癌是全球第二大常见癌症，影响着230万女性。在美国，2024年估计有310720例新的女性乳腺癌病例。现有研究已发现，基于社会经济地位（SES），乳腺癌治疗和生存存在显著差异。本系统评价考察了美国乳腺癌患者中SES的关键指标——收入、教育程度和职业与乳腺癌结局之间的关联。
方法
使用Medline®、Embase®和Web of Science进行电子检索，检索时间从数据库建立至2023年12月。纳入考察SES指标对乳腺癌结局（包括治疗接受情况、依从性和生存率）影响的观察性研究。由于SES测量方法和结局定义存在异质性，对数据进行定性总结。
结果
在检索到的2600项研究中，23项研究符合纳入标准（19项队列研究，4项横断面研究）。SES较低的女性比SES较高的女性接受推荐治疗的可能性更小或接受治疗延迟。此外，家庭收入低（<25000美元）的女性比收入50000美元及以上的女性更有可能报告治疗中断。教育水平影响治疗依从性和及时就医，教育程度越高，生存率越高。职业状况影响治疗的连续性，低薪工作和不灵活的工作时间表导致治疗延迟和中断。
结论
SES显著影响乳腺癌治疗和生存，SES较低与治疗延迟、依从性较差和结局较差相关。针对所有女性，无论其社会经济背景如何，提供公平的优质医疗服务的医疗干预措施和政策，可能会改善美国不同人口特征患者的乳腺癌结局。
