OBJECTIVES: While existing research has identified substantial disparities in breast cancer treatment and survival based on socioeconomic status (SES), the specific impact and mechanisms underlying SES on treatment utilization across a range of patient demographics remain poorly understood. This review examines the association of SES with the receipt, treatment delays, and adherence to breast cancer treatment (curative, adjuvant, and maintenance) among US women.

METHODS: An electronic search was conducted using Medline® and Embase® from inception to 10th November 2023 to identify studies reporting the socioeconomic disparities in receipt of treatment among adult women (>18 years) with stages I-III breast cancer in the US. Two independent reviewers evaluated each article at each stage of the screening process.

RESULTS: Overall, 2605 articles met the eligibility criteria for screening, while 300 articles were included in the full-text review. Preliminary findings show significant associations between SES and breast cancer treatment. Women of lower SES are less likely to receive/experience delay in receiving the recommended treatment than women of higher SES (n=30, p<0.05). In addition, women with low household income (<$25000) were significantly more likely to report discontinuing therapy as compared to women with an income of $50,000 or more (n = 2). Factors including low household income, education, and place of residence were associated with decreased adherence and persistence to breast cancer treatment, as well as an increased risk of all-cause and breast cancer-specific mortality (n = 11). Treatment delays were also observed among women living in neighborhoods with a high area deprivation index.

CONCLUSIONS: In conclusion, our preliminary findings highlight the need to tackle socioeconomic disparities in breast cancer treatment. Healthcare interventions and policies focusing on equitable access to quality care tailored to all women, regardless of their socioeconomic background, help improve breast cancer outcomes for the various demographics in the US.