BEYOND BIOLOGY: SOCIAL DETERMINANTS OF BREAST CANCER MORBIDITY AND SURVIVAL AMONG WOMEN IN LOW- AND MIDDLE-INCOME COUNTRIES: A REVIEW

Abstract

The tumour biology of breast cancer is not the sole determinant of the outcomes of breast cancer in low- and middle-income countries; the social environment in which women live and those who do not access care also play a significant role. This assignment provides a review of evidence regarding the importance of social determinants to breast-cancer morbidity and survival: education, socioeconomic status, gender norms, health-system access, and cultural beliefs. In a scoping approach with focused systematic synthesis, determinant to outcome pathways is explored, such as delays in care, stage at diagnosis, treatment access, treatment adherence, and comorbidity. The epidemiological trends in LMICs indicate that there is an increase in incidence and a continuing high mortality rate because of late detection and discontinued treatment. Indian-specific evidence points to the presence of financial toxicity, rural-urban imbalances, and genders in decision-making as the key challenges. Insurance protection, community navigation, task-shifting and tele-oncology have the potential to be used but have not been evaluated to a large scale. The review finds that to boost survival and quality of life of women with breast cancer in resource-strained environments, it is necessary to integrate the biological progress with social and health-system reforms that are grounded on equity.