A Voice in the Breast Cancer Community

Overcoming Socioeconomic Disparities in Early-Stage Breast Cancer Survival

To survive breast cancer, a woman’s income shouldn’t matter—but unfortunately, that’s not the world we live in. Here’s a frightening fact: lower-income women have five-year breast cancer survival rates that are 9 percent lower than their higher-income counterparts, according to social justice organization Breast Cancer Action.1 We at Concure Oncology believe that is unacceptable.

Of course, survival rates depend on many complex, intersecting factors. These include socioeconomic status as well as other factors like genetics, cancer type and stage at diagnosis, age, and lifestyle choices, according to Susan G. Komen.2 We’re narrowing our focus to investigate how socioeconomic differences affect access to early-stage breast cancer treatment. Then, we’ll discuss how faster post-lumpectomy radiation options like Breast Microseed Treatment® can help close that access gap.

Why lower-income women fare worse

After receiving a breast cancer diagnosis, lower-income women are more likely to delay treatment than their higher-income peers, according to a JAMA Surgery study.3 Similarly, they are less likely to complete an effective treatment plan—for instance, failing to attend all their post-lumpectomy radiation sessions.

Specifically, a study published in the Journal of the National Cancer Institute found that lower-income women were 44 percent less likely to complete multiple-session radiation treatments and three times more likely to die from breast cancer than higher-income women. The study attributed its findings to the reduced ability of lower-income women to follow long-term treatment regimens that require daily hospital visits.4

Unequal access to health care

According to the Journal of Community Health, the chief reason that women with low socioeconomic status will experience inequities, like not being able to attend multiple post-lumpectomy radiation sessions, is an issue of access, “since poverty is associated with transportation, childcare and work schedule difficulties”5 These barriers work together to make it harder for low-income women to access breast cancer treatment and, therefore, to successfully complete it, lowering their survival rates.

Barrier 1: transportation and geography

Low-income women are more likely to live in rural areas, farther from medical providers, including specialists like oncologists and radiation oncologists.6 As a result, transportation and travel time become obstacles to effective breast cancer treatment.

A study of low-income cancer patients in Texas found that in some cases, trouble with transportation led patients to forgo treatment entirely.7 Another study found that more than a quarter of lower-income patients missed or rescheduled appointments due to lack of transportation.8

However, even low-income women who live in suburban and urban settings struggle with transportation, despite their relative proximity to care. They often lack vehicles and face slow and unreliable public transportation options, according to The Atlantic.9 And for women who are disabled, obese, or chronically ill, as lower-income women are more likely to be, riding the bus or subway in itself can be a difficult undertaking.

That’s why when low-income women are faced with radiation options that require multiple visits or procedures, travel distance and time collude to prevent them from effectively completing their treatment regimens. And when women don’t complete post-lumpectomy radiation, their cancer is 2 ½ times more likely to recur, reducing their survival rate.10

Barrier 2: child care and elder care

Caretaking responsibilities more often than not fall to lower-income women who cannot pay for caretaking support. In fact, women who are caregivers are two and a half times more likely than non-caregivers to live in poverty.11 Sometimes women are caring for their children, sometimes for aging parents, and sometimes, both. As a result, time away from home becomes an obstacle to starting and completing an effective treatment plan.
A study of more than 21,000 women who had undergone breast-conserving surgery found that those with child care responsibilities were significantly less likely to be compliant with follow-up radiation therapy.12 The study explained that the women felt that they were needed at home, so they didn’t complete their treatments.

Barrier 3: work difficulties

Lower-income women are more likely to work in part-time or hourly jobs rather than in full-time, salaried positions. As a result, they are less likely to have benefits, including paid sick leave or time off from work. In fact, two-thirds of low-wage women don’t have access to paid sick time.13 That means that attending treatment can translate to a loss of necessary income and a serious risk to job security.

Furthermore, lower-income women are more likely to have irregular schedules that make finding and committing to a recurring appointment more difficult, according to the Economic Policy Institute.14 Often, lower-income women decide that the easier option is to keep working and to not complete follow-up radiation.

Closing the access gap for lower-income women

At Concure Oncology, we believe that it’s unjust that low-income women to not have equal access to health care. There is much work to be done across many areas to close the access gap, but advances in early-stage breast cancer treatment are offering one way forward.

Post-lumpectomy radiation options like Breast Microseed Treatment (a single, one-hour session) can help make breast cancer treatment more accessible for women. Because the procedure is done in a single appointment, women don’t have to keep coming back to the hospital. That simple adjustment allows women to avoid the problems that stem from juggling transportation, caretaking, or work scheduling around repeat medical appointments.

Breast Microseed Treatment has similar five-year survival rates as other post-lumpectomy radiation options.15 However, it’s more convenient, which makes it more likely to be accessible to all women—no matter their income.

Source Citations / Footnotes

1. Inequities and social justice. Breast Cancer Action website. http://www.bcaction.org/our-take-on-breast-cancer/inequities-and-social-justice/. Accessed November 20, 2016.

2. Breast cancer disparities. Susan G. Komen website. http://ww5.komen.org/BCDisparities.html. Accessed November 20, 2016.

3. Smith EC, Ziogas A, Anton-Culver H. Delay in surgical treatment and survival after breast cancer diagnosis in young women by race/ethnicity. JAMA Surg. 2013;148(6):516-523. doi: 10.1001/jamasurg.2013.1680.

4. Bradley CJ, Given CW, Roberts C. Race, socioeconomic status, and breast cancer treatment and survival. J Natl Cancer Inst. 2002;94(7):490-496. doi: 10.1093/jnci/94.7.490.

5. Kushal P, Kanu M, Liu J, et al. Factors influencing breast cancer screening in low-income African-Americans in Tennessee. J Community Health. 2014;39(5):943-950. doi: 10.1007/s10900-014-9834-x.

6. Low income families face three barriers to health care. Oregon Health & Science University website. January 20, 2011. http://www.ohsu.edu/xd/about/news_events/news/2007-news-archive/11-29-low-income-families-face.cfm. Accessed November 20, 2016.

7. Meilleur A, Subramanian SV, Plascak J, Fisher JL, Paskett ED, Lamont EB. Rural residence and cancer outcomes in the US: issues and challenges. Cancer Epidemiol Biomarkers Prev. 2013;22(10). doi: 10.1158/1055-9965.EPI-13-0404.

8. Silver D, Blustein J, Weitzman BC. Transportation to clinic: findings from a pilot clinic-based survey of low-income suburbanites. J Immigr Minor Health. 2012;14(2):350-355. doi: 10.1007/s10903-010-9410-0.

9. Cronk I. The transportation barrier. The Atlantic website. August 9, 2015.  http://www.theatlantic.com/health/archive/2015/08/the-transportation-barrier/399728/. Accessed November 20, 2016.

10. Marks LB, Prosnitz LR. Lumpectomy with and without radiation for early-stage breast cancer and DCIS. Oncology. September 1, 1997. http://www.cancernetwork.com/oncology-journal/lumpectomy-and-without-radiation-early-stage-breast-cancer-and-dcis. Accessed November 20, 2016.

11. Survey of self-identified family caregivers. National Family Caregivers Association. 2001. Caregiver Action Network website. http://www.caregiveraction.org/resources/caregiver-statistics. Accessed November 20, 2016.

12. Pan I-W, Smith BD, Shih Y-C T. Factors contributing to underuse of radiation among younger women with breast cancer. J Natl Cancer Inst. 2014;106(1). doi: 10.1093/jnci/djt340.

13. Working women need paid sick days. National Partnership for Women & Families fact sheet. May 2010. http://go.nationalpartnership.org/site/DocServer/PSD_FactSheet_WorkingWomen_080926.pdf?docID=4188. Accessed November 20, 2016.

14. Golden, L. Irregular work scheduling and its consequences. Economic Policy Institute report. April 9, 2015. http://www.epi.org/publication/irregular-work-scheduling-and-its-consequences/. Accessed November 20, 2016.

15. Concure Oncology Breast Microseed Treatment website. http://www.breastmicroseed.com/breast-microseed-treatment/outcomes.aspx. Accessed November 20, 2016



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Kevin Kelley
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