Abstract IA36: Structural and social determinants of cancer disparities

Abstract

Biologic and behavioral factors are considered the predominant contributors to incidence of cancer from most sites, and interactions between behavior and biology are well described. Contributions from social determinants of health to cancer rates and outcomes have mostly focused on access to preventive services and screening and to quality of cancer-related health care once diagnosed. For example, presentation with advanced stages of disease is most often ascribed to inadequate early detection when screening tests are recommended or to delay in consulting for symptoms when present. Both African American and Latina women have higher breast cancer mortality after completion of treatment for early-stage disease, in part as a result of inadequate annual screening following cure. Other factors such as health literacy, limited English proficiency, and low numeracy may exacerbate race/ethnic and socioeconomic disparities in cancer clinical care based on poor or ineffective communication. Structural determinants of cancer disparities refer to the built environment, the social and political system in which the patient lives, and the geographic location of home and health care. For example, an unsafe neighborhood may interfere with medical visits, obtaining medications and tests, and maintaining health-promoting activities after cancer diagnosis. Lack of adequate transportation and geographic isolation will further exacerbate access to care barriers. Race/ethnic minorities disproportionately engage with the criminal justice system, and this may interfere with obtaining quality clinical care. On the other hand, some concentrated minority neighborhoods may have tightly-woven social networks and provide community collective efficacy that can help patients and survivors going through treatment and survivorship care. Social and structural determinants of health can impact cancer outcomes across the continuum, from risk to death. Moreover, these characteristics are often highly correlated and can interact to influence disparate cancer outcomes above and beyond their individual health effects. The intersectional approach considers the impact on health and health equity of intersecting social positions and processes. To date, the intersectional approach has primarily been applied to qualitative research. In this panel, we will discuss the social and structural determinants, and the interaction among these determinants, of cancer disparities drawing on examples from the authors9 work and the published literature. Citation Format: Eliseo J. Perez-Stable, Scarlett Lin-Gomez, Scarlett Lin-Gomez, Arleen Brown. Structural and social determinants of cancer disparities [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr IA36.