The Impact of Social Determinants of Health on Breast Cancer Management Among Black Women: A Scoping Review

Breast cancer remains one of the most common diseases affecting women around the world. For decades, doctors and scientists have focused heavily on the biology of the disease: the specific genes, the type of tumor, and the chemical reactions within the body that cause it to grow. While these biological factors are critical, a growing body of evidence suggests that a person's life circumstances play an equally powerful role in whether they survive the disease. These circumstances are known as social determinants of health. They are the conditions in which people are born, grow up, work, and age. This includes things like how much money a person earns, the quality of their housing, their level of education, and whether they face discrimination or racism in their daily lives. When these social factors are negative, they can create barriers that prevent a person from getting the medical care they need, often leading to worse health outcomes. This is particularly true for Black women, who face a unique set of challenges that go beyond biology alone.

A recent review of scientific literature set out to map exactly how these life circumstances affect breast cancer management for Black women. The researchers, led by Amira Gassim-Almahdi at Western University, wanted to understand the full picture of the problem, from the moment a woman first considers a screening test to the long-term journey of survival. They were especially interested in finding out if there was enough information about this issue within Canada, a country with a publicly funded healthcare system that differs significantly from the United States. To do this, the team did not conduct new experiments or interview new patients. Instead, they gathered and analyzed 33 existing studies that had already been published between the years 2000 and 2025. They searched through major medical and scientific databases, looking for any research that connected social factors like income, housing, and racism to breast cancer outcomes for Black women. After carefully removing duplicate records and filtering out studies that did not focus on the right population or topic, they were left with a final set of 33 papers to examine in detail.

The researchers organized the findings from these studies into four main themes that tell a clear story about the obstacles Black women face. The first and most prominent theme was access to healthcare. The review found that simply having a diagnosis is not enough; the ability to get to a doctor, receive a specialist referral, and start treatment on time is often blocked by practical hurdles. These include a lack of transportation, the cost of care, and the difficulty of navigating a complex medical system. When these barriers exist, women often receive care later than they should, which can make the disease harder to treat. The second theme focused on socioeconomic factors. The studies showed a strong link between a woman's financial situation and her health. Lower income, lower levels of education, and living in neighborhoods with fewer resources were consistently associated with delayed diagnoses and a lower likelihood of completing treatment. It is not just about having insurance; it is about the ability to afford the time off work, the travel costs, and the other expenses that come with fighting cancer.

The third theme, perhaps the most profound, was the role of structural racism and discrimination. The review highlighted that Black women frequently encounter bias within the healthcare system itself. This can manifest as being treated with less respect, having their pain dismissed, or facing a general lack of trust in medical providers due to past negative experiences. This medical mistrust can lead women to delay seeking help or to avoid following medical advice, not because they do not want to be healthy, but because they feel the system is not designed to care for them fairly. The researchers noted that these experiences create a heavy psychological burden that can worsen health outcomes. Finally, the review uncovered a significant gap in the knowledge itself. While the 33 studies provided a wealth of information, 32 of them were conducted in the United States. Only one study specifically looked at the experiences of Black women in Canada. This is a crucial finding because the Canadian healthcare system is publicly funded and operates differently than the American system. The lack of Canadian data means that policymakers and doctors in Canada do not have a clear picture of how these social factors are affecting Black women within their own borders.

The author of the review emphasize that these findings suggest the solution to unequal breast cancer outcomes cannot be found in medicine alone. The disparities are driven by broader social and structural imbalances that exist outside the hospital walls. To improve the situation, the researchers argue that efforts must go beyond clinical care. They suggest that healthcare organizations need to create programs that help women navigate the system, such as patient navigation services that guide them through appointments and treatments. They also call for better education for medical professionals to help them understand cultural safety and the impact of racism on health. Furthermore, the review points out that future research must focus on the Canadian context. Without specific data on how Black women experience the Canadian healthcare system, it is difficult to design policies that truly work for them. The study concludes that achieving equity in breast cancer care requires a coordinated effort to address the social conditions that shape health, ensuring that every woman, regardless of her background, has a fair chance at survival.