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Breast cancer disparity equally driven by social determinants of health and tumor biology

A new study of more than 60,000 Black and White women diagnosed with stage 1 and stage 2 estrogen receptor-positive breast cancers, the most common type of breast cancer that generally has the most favorable prognosis, validates the role of social determinants of health as a root cause of racial disparities in breast cancer outcomes, according to the researchers.

The researchers calculated the effect of social determinants of health — specifically neighborhood disadvantage and insurance status — on mortality and found they accounted for 19 percent of the disparity in deaths. They also calculated the effect of biological characteristics of the tumors by looking at data from genomic laboratory test results, which were used to anticipate tumor response to chemotherapy and likelihood of recurrence. They found tumor biology accounted for 20 percent of the disparity.

“This study added to our understanding of this public health problem by demonstrating conclusively that disproportionately aggressive tumor biology in Black women not only contributes to disparate outcomes but appears to be as important as social disadvantage,” said the lead author Kent Hoskins, M.D., of the Illinois Cancer Center at the University of Illinis Chicago. “The study also suggested that social factors may actually be driving some of the racial difference in tumor biology.”

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