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Social determinants of health and disparities in cancer care for patients with metastatic breast cancer in Mexico.
(American Society of Clinical Oncology (ASCO), 2025)
Chavarri Guerra, Yanin
;
Verduzco-Aguirre, Haydee Cristina
;
Esparza-Orozco, Maria Fernanda
;
Ramos Lopez, Wendy Alicia
;
Alvarado, Montserrath
Background: Patients diagnosed with metastatic breast cancer (MBC) in low- and middle-income countries (LMICs) face poorer outcomes than their counterparts in high-income countries. Social determinants of health (SDH)—including housing, food security, employment, and education—have been increasingly recognized as critical non-medical factors influencing access to care and cancer-related outcomes. We aimed to describe SDH among Mexican patients with MBC and examine their association with treatment adherence, receipt of standard therapy, and survival. Methods: This was a prospective multicenter cohort study including patients from three public cancer centers in Mexico City. Eligible participants were adults with MBC receiving first- or second-line systemic therapy. A trained patient navigator conducted structured interviews at baseline and every three months over one year using validated questionnaires (SDH needs, SEAMS, FACT-G, and BPI). Treatments were categorized as standard or non-standard based on NCCN guidelines. Associations between SDH and clinical outcomes were explored using chi-square tests. Linear mixed models were used to assess longitudinal changes in health-related quality of life. Survival was estimated using the Kaplan-Meier method and compared with the log-rank test. Results: A total of 324 patients were included (mean age 58.1 years; 99.7% female). At baseline, 92% reported at least one SDH-related need, most commonly employment (77.5%), housing (55.2%), and food (45.7%). The mean number of SDH needs at baseline was 3.1±1.8, remaining consistent across timepoints. Receipt of standard treatment was lower among those with needs in utilities (47.6% vs. 69.1%, p= 0.001) and education (58.0% vs. 69.0%, p= 0.046). Median SEAMS scores improved slightly over time (35 to 37). Median follow-up was 12.1 months (95% CI, 12.05-12.15). One-year overall survival was 85.0% (95% CI, 81.0–89.0), with no differences based on presence (p = 0.61) or number of SDH needs (p = 0.51) at baseline. The presence of any SDH need was significantly associated with FACT-G scores (p = 0.002) throughout the follow-up period. FACT-G scores were consistently lower in patients with any SDH need, and no significant interaction was observed between time and presence of any SDH need (p = 0.481). Conclusions: SDH needs were highly prevalent and persistent among patients with MBC in Mexico and were associated with lower likelihood of receiving guideline-concordant care and lower quality of life. Addressing these social barriers through targeted interventions may be critical to improving treatment equity and clinical outcomes in LMIC settings. ©The authors ©American Society of Clinical Oncology.
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Attitudes and knowledge towards breast cancer among non-healthcare workers at an educational institution
(American Society of Clinical Oncology (ASCO), 2025)
Esparza-Orozco, Maria Fernanda
;
Esparza Orozco, Raúl Emiliano
;
Cruz-Zermeño, Mayte
;
Mendez-Bribiesca, Sofia Alejandra
;
Lagunas-Medina, Alex
Background: Breast cancer (BC) is the leading cause of cancer-related death among Mexican women. Knowledge about BC is limited and often restricted to healthcare workers. Evaluating knowledge among non-healthcare workers (non-HCWs) allows us to depict a more realistic view of the general population's awareness. This study aimed to evaluate knowledge and attitudes towards BC among non-HCWs in a private educational institution. Methods: A validated and translated 32-item electronic questionnaire was administered to non-HCWs of an educational institution with or without personal/family history of cancer, teachers and medical staff were excluded. It assessed BC warning signs, breast self-examination (BSE), and screening practices. Sociodemographic data were collected. Descriptive statistics and Pearson’s test were used for analysis. Results: Of 119 eligible participants, 102 (60% women, median age 43 [range 21–62]) completed the survey; 47% were maintenance and 32% security staff. Most were married (44%) and had completed high school (31%); 13% had a university degree. 97% had no personal history of cancer, and 50% reported a family history of cancer. An average of 8.1 (SD ±2.2) out of 11. BC warning signs were identified. Women identified more than men (8.5 vs. 7.6, p = 0.02). The most recognized sign was a breast lump (85.2%); the least was nipple inversion (54.9%). Family (59%) and personal (57%) history of BC were the most commonly identified risk factors; late menopause was the least (9.8%). Regarding BSE, 38% rarely or never performed it, especially men (65%), individuals < 40 years (41%), and those without family history (41%). Women performed BSE more frequently, 30.6% reported weekly practice. BSE was more common among women (80%), > 40yo (65%), and those with family history (84%). While 86% felt confident detecting breast changes, confidence was lower in men and < 40yo (both 15%). Most (90.1%) would consult a physician when detecting a change. For BC screening, 81% were aware of screening tests, 43.3% knew the correct starting age and none knew the stopping age (p < 0.05). Misreporting the starting age was more common among men (80%), < 40yo (63%), and those without family history (60%). Women (58%), > 40yo (46%), and those with family history (47%) responded more accurately. 53.2% of women reported being invited to a BC detection program, and 74% had undergone screening. 10.7% of screening-eligible women had not yet started it. No other significant association was found. Conclusions: While BC signs were widely recognized, knowledge of risk factors and screening was limited, particularly among men and younger participants. Findings highlight the need for targeted education strategies to improve BC awareness among non-HCWs. ©The authors ©American Society of Clinical Oncology.

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