Breast cancer disparities: A literature review of the last five years.
Authors: Anamika Fnu , Chitkara Akshit , Gutierrez Victoria , Gupta Kavvya , Tarabey Ledia , Srivastava Anil , Adsul Prajakta , Ramaswamy Bhuvaneswari , Mehrotra Ravi , Singh Keshav Kumar , Lopez Ana Maria 
Published: June 2023

e18686

Background: Breast cancer (BC) disparities are differences in cancer measures. Some of the disparities in BC among Black women and males include but are not limited to the disproportionate high mortality rates impacted by access to screening mammograms, the effect of breast density, access to genetic testing, genetic predisposition to triple-negative BC (TNBC), and other social constructs that prevent obtaining BC screening. We highlight disparities in BC among women of minority and lower socioeconomic status, discuss factors contributing to this racial disparity, and design innovative solutions to address these disparities. Methods: The PRISMA statements were followed for conducting this literature review. A comprehensive staged literature search was performed on PubMed, EMBASE, clinicaltrial.gov, Web of Science, and Cochrane Library, identifying relevant Medical Subject Headings (MeSH) keywords. Two investigators performed an independent literature search using the search terms. A third reviewer resolved conflicts. Articles with a publication date before 2017, those written in languages other than English, and those without data on BC Disparity were excluded. Results: Using the Mesh framework outlined, we accumulated 4125 studies. Studies were further screened for relevance to this project, leading to the inclusion of 35 studies. The literature shows that both non-modifiable and modifiable risk factors contribute to these racial disparities. The expression of cytokines and other chemical messengers in the tumor microenvironment is differential and prevalent in Black women. Furthermore, this tumor microenvironment is impacted by non-genetic risk factors, including obesity, consumption of alcohol and tobacco, and poverty. Another critical component of racial disparities in BC includes the social element of poorer medical care for women in the US. For example, lower breastfeeding rates in Black women are highly influenced by social factors, although it was found that breastfeeding is protective against TNBC. In addition, poor and near-poor women were less likely to receive sentinel lymph node biopsy and radiation after breast-conserving surgery than high socioeconomic-status women. Conclusions: In our study, we highlight how black women have higher mortality rates at any age of diagnosis than white women. It exemplifies the need to advocate for better healthcare for minority women. Precision cancer prevention is the key to addressing BC disparity based on geographic, socioeconomic, and racial factors. Rural healthcare centers in high-risk areas outside the catchment of existing National Cancer Institutes (NCI) can play a vital role in screening and managing BC survivors. We will need a multidisciplinary platform of investigators, including but not limited to internists using digital tools to improve breast cancer education and awareness of primary healthcare providers and community workers.