Socioeconomic Status and Breast Cancer Treatment in the United States: Results From a Systematic Literature Review

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.