Social Determinants of Health and Breast Cancer: What to Know
Some communities have stores stocked with fresh fruits and veggies, lots of transportation options for getting to and from places, and local parks for relaxing with friends. In other communities, however, fresh foods and transportation are hard to find, schools are underresourced, and people don’t feel safe.
The community where you live and work and the resources (such as clean, green spaces or good job opportunities) that are or are not available to you can affect your health, including breast cancer screening, diagnosis, and treatment. Researchers call these factors social determinants of health.
“[Social determinants of health] are present everywhere in our daily lives,” says Lea Sacca, PhD, MPH, an assistant professor at Florida Atlantic University. It’s important to study these factors to ensure that all people have a fair opportunity to be as healthy as possible, she says.
Researchers group social determinants of health (SDOH) into five main categories:
Economic stability: your job and how much money you have may influence where you live and whether you can afford health insurance.
Education access and quality: high-quality early education, high school graduation, and college may help you get higher-paying jobs and quality health care.
Healthcare access and quality: health insurance and proximity to healthcare providers can make a difference in when, where, and how often you access health services.
Neighborhood and built environment: natural green spaces (such as community gardens or nature areas) and easy walking around your neighborhood are good for your health.
Social and community: the quality of your relationships with family, friends, coworkers, and community members can have a major impact on your health.
People who have less money, live in underresourced neighborhoods, and must deal with other challenging social determinants of health may be more likely to have health problems than those who don’t face these problems. Health problems that affect one group more than others are called health disparities. Many health disparities are rooted in systemic and structural racism. One example of the link between social determinants of health and health disparities traces back to nearly 100 years ago in the U.S. In the 1930s, a racist policy known as redlining prevented many Black and Brown people in the U.S. from owning a home in certain neighborhoods. This led to big differences in the wealth these communities could accumulate.
Although redlining was outlawed in the 1960s, studies show that people who live in neighborhoods that were once redlined have more health problems than those who don’t live in these neighborhoods.
Social determinants affect all stages of breast cancer care — from who gets mammograms and when to who is invited to participate in clinical trials and lives the longest after a breast cancer diagnosis. A few of the many examples of health disparities in breast cancer appear below.
Breast cancer screening is important for the early detection and treatment of breast cancer. If screening isn’t something that people can easily schedule, people might be at greater risk of late-stage diagnosis down the line.
One study found that women who were Asian American, Black, and Latinx; women with less education; and women with lower incomes had less access to 3D screening mammograms compared to white women, more educated women, and those with higher incomes.
Likewise, a review of more than 70 studies that Sacca led found that socioeconomic status and healthcare access played a big role in whether or not a person received breast cancer screening. One study her team reviewed found that Medicaid patients who have co-pays for preventive services and follow-up visits are less likely to seek screening. Another study found that mammography screening rates were higher in states that insured more people using Medicaid compared with those states that didn’t increase access to Medicaid. Research also suggests that women with lower incomes are more likely to have mammograms when they have access to food stamps.
Research has shown that poverty, racial discrimination, lack of social support, and other social determinants of health can influence the stage of breast cancer at the time of diagnosis.
One study showed that when states expanded Medicaid to cover more people, the fewer people were diagnosed with advanced-stage breast cancer. Black women and women under the age of 50 years experienced the greatest benefit.
Clinical trials are used to develop treatments for breast cancer. If trials don’t represent a diverse population, those treatments are less likely to work for everyone. In the U.S., people belonging to racial and ethnic minority groups are underrepresented in breast cancer clinical trials.
Some groups are also more or less likely to receive therapy that follows recommended treatment guidelines. For instance, a 2021 study found that Black women who had been diagnosed with triple-negative breast cancer were less likely to receive surgery and chemotherapy compared with white women with the same diagnosis. Another study found that people receiving radiation therapy had higher rates of financial toxicity than people who weren’t receiving radiation therapy.
Research has also found that Black, Hispanic, Asian, Pacific Islander, and Native American women are less likely to have immediate breast reconstruction than white women — even when they live in the same area and have the same insurance.
Studies also show that race, socioeconomic status, income, state investment in social services access to health insurance and preventive care, and more influence the odds of survival after a breast cancer diagnosis.
Compared to white women, black women are more likely to die from all types of breast cancer. Researchers have attributed this survival disparity to social determinants of health and the fact that Black women are more likely to be diagnosed with more aggressive tumors.
Questions your doctor may ask you
Your healthcare provider may ask you questions about factors in your daily life that may be affecting your health. For instance, you may be asked: “What is the highest level of school you have completed?” or “Are you easily able to get enough healthy food to eat?”
Based on your responses, your healthcare provider may be able to connect you with resources in your community that can help support you. They can refer you to community resources such as food pantries, transportation assistance, and housing programs.
It’s important that social determinants of health are factored into how doctors and other health care providers think about treating breast cancer and other health disparities, says Tina Sacks, PhD, an associate professor of social welfare at UC Berkeley. Sacks studies health disparities and social determinants of health.
According to Sacks, more and more healthcare spaces and organizations are starting to address social determinants of health. For example, Memorial Sloan Kettering Cancer Center runs food pantries at some of its cancer clinics as part of the Food to Overcome Outcome Disparities Program. Some hospital systems, including Boston Medical Center and Dartmouth Health, have put millions of dollars toward local affordable housing programs in the neighborhoods where patients live.
What can you do?
Many social determinants of health are outside of your control. However, there are steps you can take to advocate for yourself when you’re with your healthcare provider. For instance, you can ask yourself the questions in the American Academy of Family Physicians' Social Needs Screening Tool before your next healthcare visit and discuss your results with a healthcare provider.
If your provider doesn’t speak the language that you or the people with you speak, you can ask for a translator. You can also ask for assistance from community health workers who can help you navigate a treatment plan. If you can’t afford your medications, you may want to ask your provider about other, more affordable options.
— Last updated on May 31, 2025 at 9:58 PM