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Current Oncology
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Social Determinants of Health and Breast Cancer: Impacts on Diagnosis,...
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Social Determinants of Health and Breast Cancer: Impacts on Diagnosis, Treatment, and Outcomes

A special issue of Current Oncology (ISSN 1718-7729). This special issue belongs to the section "Breast Cancer".

Deadline for manuscript submissions: closed (15 December 2025) | Viewed by 11307

Special Issue Editors

Dr. Charlotte Yong-Hing

E-Mail Website
Guest Editor
Department of Radiology, University of British Columbia, Vancouver, BC, Canada
Interests: breast imaging; radiology equity; diversity; breast cancer screening; healthcare policy
Dr. Nathalie LeVasseur

E-Mail Website
Guest Editor
1. Medical Oncology, BC Cancer Agency, Vancouver, BC V5Z 4E6, Canada
2. Faculty of Medicine and Health Sciences, Faculty of Medicine, University of British Columbia, Vancouver, BC V5Z 4E6, Canada
Interests: development of personalized oncology and the improvement of patient outcomes and survivorship programs
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

The Special Issue of Current Oncology, "Social Determinants of Health and Breast Cancer: Impacts on Diagnosis, Treatment, and Outcomes", aims to explore the complex interplay between socioeconomic factors and breast cancer care.

This issue will address how determinants such as race, ethnicity, income, education, and geographic location affect breast cancer screening, diagnosis, treatment options, and outcomes. By examining these disparities, the issue seeks to highlight barriers to equitable healthcare access and quality. 

Contributions from a multidisciplinary perspective, including public health, radiology, oncology, and healthcare policy, will provide insights into strategies for addressing these inequities and improving outcomes for marginalized populations. 

In this Special Issue, original research articles and reviews are welcome. 

I look forward to receiving your contributions.

Dr. Charlotte Yong-Hing
Dr. Nathalie LeVasseur
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 250 words) can be sent to the Editorial Office for assessment.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Current Oncology is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2200 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • social determinants of health
  • breast cancer disparities
  • healthcare access
  • health equity
  • screening and diagnosis
  • treatment outcomes
  • socioeconomic factors
  • racial and ethnic disparities
  • healthcare policy
  • marginalized populations

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Published Papers (5 papers)

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Research

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21 pages, 336 KB  
Article
Socio-Demographic Inequalities in Diagnostic Delays of Breast Cancer: A Multistage Time-to-Diagnosis Analysis
by Oana Maria Burciu, Tudor Gramada, Smaranda Gramada-Stefurac, Raluca-Alina Plesca, Cristina Macuc, Andreea-Lucia Viforeanu, Ioan Sas, Aida Iancu, Adrian-Grigore Merce, Ionut Marcel Cobec and Gabriel Mihail Dimofte
Curr. Oncol. 2025, 32(12), 674; https://doi.org/10.3390/curroncol32120674 - 1 Dec 2025
Viewed by 668
Abstract
Background/Objectives: Introduction: Breast cancer remains a leading cause of cancer morbidity and mortality among women, and timely diagnosis is critical for improving outcomes. Organized screening programs strive to function efficiently, with minimal delays; however, evidence indicates that longer waiting times may be present [...] Read more.
Background/Objectives: Introduction: Breast cancer remains a leading cause of cancer morbidity and mortality among women, and timely diagnosis is critical for improving outcomes. Organized screening programs strive to function efficiently, with minimal delays; however, evidence indicates that longer waiting times may be present at different stages of the diagnostic process. Few studies have evaluated how socio-demographic, reproductive, lifestyle, and clinical characteristics may influence diagnostic timeliness in a regional screening context. Materials and Methods: We retrospectively analyzed data from 240 women who underwent breast biopsy following abnormal screening assessment, out of 24,000 patients enrolled in a regional breast cancer screening program conducted in Northeastern and Southeastern Romania. Diagnostic timeliness was observed across three consecutive intervals of the screening pathway: mammography to biopsy (T1), biopsy to histopathological confirmation (T2), and cumulative presentation-to-diagnosis time (T3). Baseline population characteristics were described, subgroup comparisons performed, and multivariable regression models applied to identify independent predictors of diagnostic delay and to explore interaction effects at different stages of the screening process. Results: The interval between mammography and biopsy accounted for the most substantial waiting times (T1 median 24 days). The cumulative time to diagnosis (T3) reached a median of 32 days. Territorial inequalities were the strongest determinant of delay: rural patients experienced approximately five additional days before histopathological confirmation compared with urban patients (p = 0.003). Social vulnerability further contributed to prolonged T1 and T3 intervals, while lifestyle, reproductive, and anthropometric factors showed only minor or inconsistent associations. Interaction analyses revealed that delays linked to rural residence were most pronounced among younger women, an age group at higher risk for aggressive subtypes such as triple-negative breast cancer. Conclusions: In our findings, regional background and social vulnerability outweighed individual risk factors in shaping total diagnostic time. These results support the careful monitoring of interval-specific performance to strengthen equitable access to biopsy among vulnerable populations, where the effectiveness of early breast cancer detection is often challenged. Full article
(This article belongs to the Special Issue Social Determinants of Health and Breast Cancer: Impacts on Diagnosis, Treatment, and Outcomes)
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14 pages, 715 KB  
Article
Breast Cancer Characteristics and Outcomes in Canadian Black Women by Ancestry
by Anna N. Wilkinson, Aisha Lofters, Moira Rushton, Jean M. Seely and Carmina Ng
Curr. Oncol. 2025, 32(11), 616; https://doi.org/10.3390/curroncol32110616 - 4 Nov 2025
Viewed by 1552
Abstract
Breast cancer is the most common cancer among women in Canada. Its presentation and outcomes vary significantly by race/ethnicity. This study explores breast cancer incidence, age at diagnosis, stage, subtype, and mortality, comparing Black and White women aged 20 years and older, using [...] Read more.
Breast cancer is the most common cancer among women in Canada. Its presentation and outcomes vary significantly by race/ethnicity. This study explores breast cancer incidence, age at diagnosis, stage, subtype, and mortality, comparing Black and White women aged 20 years and older, using the 2011 and 2016 Canadian Census Health and Environment Cohorts databases. Black women were disaggregated into Caribbean, Central/West African (C/WA), Southern/East African (S/EA), and “Other” ancestry groups. The Black female study population had a lower mean age (43.0 years) than the White (50.5 years). Black women had lower overall age-standardized breast cancer incidence than White women. The age-specific incidence in Black women ages 30–39 of Caribbean origin was higher (RR 95% CL, 1.36, 1.04–1.79; 58.7 vs. 43.1 cases/100,000 person-years) than in White. White women had 14.6% of cases diagnosed at ages 20–49 compared to over 50% in Black women of C/WA and S/EA origins, with highest proportions of diagnoses occurring at least 10 years earlier among Black women (C/WA 46, S/EA 48, Caribbean 57, White 67). Proportions of prognostic stage I diagnoses were less common among Black vs. White women (53.2% vs. 65.9%, p < 0.0001), and triple negative breast cancer was more frequent among Black women (17.1% vs. 9.9%, p < 0.0001), particularly those of Central/West African ancestry (21.8%). Higher age-specific mortality was observed among Black women with Caribbean origins aged 40–49 (RR 95% CL, 1.70, 1.19–2.42) and 50–59 (RR 95% CL, 1.42, 1.08–1.88) compared to White women. Breast cancer characteristics and outcomes vary substantially by ancestry within Canada’s Black population. Tailored screening strategies accounting for earlier onset and aggressive subtypes may help mitigate disparities. Full article
(This article belongs to the Special Issue Social Determinants of Health and Breast Cancer: Impacts on Diagnosis, Treatment, and Outcomes)
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22 pages, 1224 KB  
Article
Beyond Biology: Uncovering Structural and Sociocultural Predictors of Breast Cancer Incidence Worldwide
by Janet Diaz-Martinez, Gustavo A. Hernández-Fuentes, Josuel Delgado-Enciso, Mario A. Alcalá-Pérez, Isaac Jiménez-Calvo, Carmen A. Sánchez-Ramírez, Fabian Rojas-Larios, Alejandrina Rodriguez-Hernandez, Mario Ramírez-Flores, José Guzmán-Esquivel, Karmina Sánchez-Meza, Ana C. Espíritu-Mojarro, Osval A. Montesinos-López and Iván Delgado-Enciso
Curr. Oncol. 2025, 32(10), 553; https://doi.org/10.3390/curroncol32100553 - 2 Oct 2025
Viewed by 1692
Abstract
Breast cancer remains a leading cause of global cancer burden, with marked differences in incidence across countries. While biological risk factors are well established, understanding the broader structural and sociocultural influences has been less comprehensive. In this study, we analyzed harmonized data from [...] Read more.
Breast cancer remains a leading cause of global cancer burden, with marked differences in incidence across countries. While biological risk factors are well established, understanding the broader structural and sociocultural influences has been less comprehensive. In this study, we analyzed harmonized data from 183 countries (2017–2023), encompassing 33 variables and 7 subvariables related to demographics, nutrition, environment, health, and healthcare access, drawn from open-access international databases. Spearman correlation analysis identified strong positive associations between breast cancer incidence and discontinued breastfeeding, high LDL cholesterol, out-of-pocket healthcare expenditure, and educational attainment. Conversely, poor sanitation, lack of handwashing facilities, unsafe water, and certain nutritional deficiencies exhibited robust negative correlations, likely reflecting under detection and reporting limitations in lower-resource settings rather than true protective effects. These findings were further explored using multiple linear regression, which explained approximately 73% of the variance in global breast cancer incidence. The final model highlighted discontinued breastfeeding, prevalence of cocaine use, unsafe sanitation, high out-of-pocket healthcare expenditure, limited handwashing access, and high processed meat consumption as the most influential independent predictors. Receiver operating characteristic (ROC) analysis confirmed strong predictive value for discontinued breastfeeding and out-of-pocket expenditure, with sanitation and hygiene variables showing paradoxical inverse associations. Our results emphasize that breast cancer risk is shaped not only by individual behaviors and genetics, but also by larger-scale structural, socioeconomic, and environmental factors. These patterns suggest that targeted interventions addressing both lifestyle behaviors and systemic inequities—such as promoting breastfeeding, reducing financial barriers to healthcare, and strengthening public health infrastructure—could meaningfully reduce the global burden of breast cancer. In conclusion, this study underscores the importance of multisectoral, equity-focused prevention strategies. It also highlights the value of country-level ecological analyses in uncovering upstream determinants of cancer incidence and calls for further research to disentangle individual and contextual effects in cancer epidemiology. Full article
(This article belongs to the Special Issue Social Determinants of Health and Breast Cancer: Impacts on Diagnosis, Treatment, and Outcomes)
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13 pages, 750 KB  
Article
First-Line (1L) Treatment Decision Patterns and Survival of Hormone Receptor (HR)-Positive/HER2-Negative Advanced Breast Cancer (ABC) Patients in a Latin American (LATAM) Public Institution
by Guillermo Valencia, Patricia Rioja, Miguel Chirito, Olenka Peralta, Jorge Sánchez, Connie Rabanal, Raúl Mantilla, Zaida Morante, Hugo Fuentes, Carlos Castaneda, Tatiana Vidaurre, Cristian Pacheco, Silvia Neciosup and Henry L. Gomez
Curr. Oncol. 2024, 31(12), 7890-7902; https://doi.org/10.3390/curroncol31120581 - 9 Dec 2024
Cited by 1 | Viewed by 3469
Abstract
Advanced breast cancer is an incurable disease, with a median overall survival of 3 years, including in countries without access problems. Although chemotherapy is reserved in some cases, it is still used in many countries as a first-line therapy. The aim of our [...] Read more.
Advanced breast cancer is an incurable disease, with a median overall survival of 3 years, including in countries without access problems. Although chemotherapy is reserved in some cases, it is still used in many countries as a first-line therapy. The aim of our study is to evaluate the first-line treatment choices and the factors that influence therapeutic decisions. A retrospective analysis was conducted of hormone receptor (+)/HER2 (−) advanced breast cancer patients classified into three groups according to the first-line and second-line treatment received: endocrine therapy–chemotherapy, endocrine therapy–endocrine therapy and chemotherapy–endocrine therapy. Additionally, we explored the overall survival of sequencing therapy groups. First-line chemotherapy was chosen in 34% of patients. Also, around 60% of our patients met the “aggressive disease” criteria from the RIGHT Choice trial, justifying the use of chemotherapy in a population with poor prognosis. Furthermore, de novo and progressive disease were prognostic factors that influenced the use of chemotherapy as a first-line treatment. Regarding overall survival, the sequencing treatment groups in this trial saw an increase in survival compared with patients of the MONALEESA trials (endocrine therapy alone arms). No significant differences in progression-free survival or overall survival were found in the treatment sequencing groups. There was a higher use of chemotherapy as a first-line therapy, with de novo and “aggressive disease” criteria being the main factors to influence the decision. Full article
(This article belongs to the Special Issue Social Determinants of Health and Breast Cancer: Impacts on Diagnosis, Treatment, and Outcomes)
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Review

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11 pages, 232 KB  
Review
When “One Size Fits All” Fits None: A Commentary on the Impacts of the“Draft Canadian Breast Cancer Screening Guidelines” on Racialized Populations in Canada
by Beverley Osei, Gayathri Naganathan, Juliet M. Daniel, Supriya Kulkarni, Aisha Lofters, Yinka Oladele, Leila Springer and Mojola Omole
Curr. Oncol. 2025, 32(3), 123; https://doi.org/10.3390/curroncol32030123 - 22 Feb 2025
Viewed by 3063
Abstract
Epidemiological data show racial and ethnic differences exist in breast cancer morbidity and mortality amongst Black, Indigenous, Asian, and Hispanic populations, with non-white females experiencing earlier age at diagnosis, more aggressive breast cancer subtypes and advanced cancer stages, and earlier mortality than white [...] Read more.
Epidemiological data show racial and ethnic differences exist in breast cancer morbidity and mortality amongst Black, Indigenous, Asian, and Hispanic populations, with non-white females experiencing earlier age at diagnosis, more aggressive breast cancer subtypes and advanced cancer stages, and earlier mortality than white females. However, the current Canadian breast cancer screening guidelines recommend biannual screening for all females starting from age 50 to age 74 and suggest not to screen individuals aged 40–49. In May 2024, the Canadian Task Force for Preventative Health released updated draft breast cancer screening guidelines, maintaining such recommendations for screening. Both the existing and the proposed guidelines fail to account for the unique cancer burden amongst racialized populations in Canada and risk further perpetuation of existing racial and ethnic disparities by underscreening racialized females. This commentary will present data regarding racial disparities in cancer burden, highlighting the role social and biological factors play in impacting cancer risk and age of disease and presenting perspectives from stakeholder groups reflecting the impacts of current screening guidelines. Ultimately, we critique the current “one-size-fits-all” approach to breast cancer screening in Canada, emphasizing the need for adapted screening practices with the understanding that the current approaches overlook the needs of racialized Canadian populations. Full article
(This article belongs to the Special Issue Social Determinants of Health and Breast Cancer: Impacts on Diagnosis, Treatment, and Outcomes)
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