The social determinants associated with decreased rate of breast cancer screening, delayed presentation, and advanced stage diagnosis of breast cancer: A systematic review

Abstract

Background: There are many barriers that hinder breast cancer (BC) early detection such as social, demographic, and economic factors. We examined the barriers to early detection. Methods: PubMed, Scopus, and Web of Science databases were chosen to conduct a comprehensive literature search. The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) was used to select the relevant studies on decreased rate of BC screening, delayed presentation of BC, and advanced stage diagnosis of BC. Results: The literature demonstrates that several determinants had a significant impact on the delay in seeking medical help, rate of performing breast cancer screening (BCS), and stage at diagnosis of BC. Younger age, rural residence, being non-white, being single, low socioeconomic status, absence of medical insurance, having no paid job, low educational level, positive family history of BC, and having TNBC or HER2E BC subtypes were significantly associated with presenting at advanced stages, decreased rate of BCS, and delayed presentation. Meanwhile, the associations between BC and BMI, parity, religion, and menopausal status were underexamined in the literature. Conclusion: Promoting early detection of BC should be taking the sociodemographic disparities into consideration. To address these disparities, raising public awareness, implementing universal health coverage (UHC), and increasing government expenditure on health and education are needed, especially among vulnerable societies.