Although less common than in older adults, adolescents and young adults (AYAs) aged 15 to 39 years can have breast cancer. A CDC-funded research study assessed the needs of historically underserved AYA populations and the impacts of social determinants on their health outcomes.
Social Determinants of Cancer Risks and Survival
Social determinants of health (SDH) are the non-medical factors that influence people’s health, functioning, and quality of life. Examples of SDH, among others, include income, education, unemployment and job insecurity, working life conditions, food insecurity, housing, early childhood development, and access to affordable health services.
Research shows that the social determinants can be more important than healthcare or lifestyle choices in influencing health outcomes. According to the World Health Organization, social determinants of health account for between 30% to 55% of health outcomes.1
Among the many social determinants of health, socioeconomic factors such as unemployment, lack of education, poverty, and income inequality are among the most important determinants of disparate health outcomes.
For example, in a study of 13,234 adults diagnosed with a common cancer (female breast, colorectal, prostate, lung and bronchus, uterine, cervix, ovarian, melanoma, or urinary bladder), researchers found that higher socioeconomic status (health insurance, education, income, and poverty status) is associated with favorable cancer survival. In comparison with patients with cancer who have private insurance, better education, and higher income, patients with low socioeconomic status have significantly decreased survival time from diagnosis.2
Other social determinants such as neighborhood disadvantage, residential segregation by race, racial discrimination, lack of social support, and social isolation also play an important role in affecting cancer outcomes. For instance, neighborhood conditions are associated with a broad range of exposures related to health, including access to medical care, proximity to grocery stores and the availability of nutritious foods, and safe places to exercise. There is a clear association between unequal living standards and increased levels of comorbid diseases.3
To address these social determinants and eliminate cancer disparities, effective interventions are needed that account for the social and environmental contexts in which patients with cancer live and are treated.
Social Barriers for Adolescent and Young Adult Breast Cancer Survivors
Although less common than in older adults, adolescents and young adults (AYAs) aged 15 to 39 years can have breast cancer. Female AYAs may face many of the same challenges as other cancer survivors, but some concerns, such as childcare and impairment of fertility, are especially salient for them. Financial toxicity is particularly problematic because many AYAs are in the early years of employment.4
Supported by a CDC grant, the Breast Cancer Resource Center of Texas (BCRC), a community-based nonprofit community organization, conducted a focus group study of 33 cancer survivors to assess the needs of female AYA breast cancer survivors who may be from racial/ethnic minority groups, and/or have low income, live outside urban settings, and/or have metastatic cancer.
Some barriers specific to AYA survivors emerged from this study. For instance, support group meetings during work hours were difficult to attend, delays in getting diagnostic tests (eg, mammograms) because of their young age, childcare needs during medical appointments, complementary treatment services to address mental health, among others were identified. Body image changes, femininity, sexuality, and premature menopause were also mentioned as especially key for AYAs as they have a lot of life ahead of them.
This study also suggested that healthcare providers need to think beyond medical diagnosis and treatment and communicate information about long-term symptom management, signs of recurrence or metastasis, and complementary therapies—particularly mental health services. This communication must take into account social determinants of health, such as race/ethnicity and health literacy.
➤ To learn more about this original research study, read What AYAs with Breast Cancer and Their Providers Tell Us About Survivorship Needs from the recent issue of Journal of Oncology Navigation & Survivorship (JONS), a publication that features topics related to patient navigation and survivorship care, offering original research, best practices, interviews, case reports, study highlights, and more.
References:
- Social Determinants of Health. https://www.who.int/health-topics/social-determinants-of-health#tab=tab_1. Accessed May 2, 2022.
- Du XL, Lin CC, Johnson NJ, Johnson NJ, and Altekruse S. Effects of Individual-Level Socioeconomic Factors on Racial Disparities in Cancer Treatment and Survival: Findings from the National Longitudinal Mortality Study, 1979–2003. Cancer. 2011 July 15; 117(14): 3242-3251.
- Coughlin, S. Social Determinants of Breast Cancer Risk, Stage, and Survival. Breast Cancer Research and Treatment. 2019(177):537-548.
- Becker H, McAdam M, Malatok S, et al. What AYAs with Breast Cancer and Their Providers Tell Us About Survivorship Needs. Journal of Oncology Navigation & Survivorship. 2022,13(4). https://jons-online.com/issues/2022/april-2022-vol-13-no-4/4492-what-ayas-with-breast-cancer-and-their-providers-tell-us-about-survivorship-needs. Accessed May 2, 2022.
