The Impact of Social Determinants of Health on Breast Cancer Surgery Treatment Choice: A Scoping Review

Abstract

This scoping review sought to examine existing studies that have identified social determinants of health associated with differences in receipt of  breast conserving surgery (lumpectomy with radiation) vs. mastectomy (with or without reconstruction)  in individuals diagnosed with breast cancer to determine areas of future research and inform local quality improvement efforts. 

METHODS:The health sciences librarian developed the search strategy by using keywords and subject headings for four concepts: breast cancer, Hispanic and Black populations, specific breast cancer treatments (breast conserving treatments or total mastectomy), and health disparities or socioeconomic factors. Two databases, PubMed (NLM) and Web ofScience (Clarivate), were searched during the month of August 2022. There were 2105 unique results, which were uploaded into Rayaan for screening. 46 studies were identified for full review and 20 were included in data extraction and qualitative analysis. 

RESULTS:  Eighteen social determinants of health (SDOH) were found to be associated with treatment disparities. Rural residence, lower socio-economic status, education beyond high school, marital status, white race, treatment at county hospital (v. private), and high self-reported family-influence on treatment decisions were associated with mastectomy. Surgery by a breast surgeon (v. general surgeon), Medicare enrollment, Spanish-language predominance, and higher BMI were associated with breast conserving surgery treatment (BCS). 

DISCUSSION: Not all findings were consistently associated with BCS or mastectomy. This reflects a need for further qualitative and quantitative studies to better characterize the intersection of these factors with patient preferences in the formulation of treatment decisions to reduce existing disparities and properly counsel patients.