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Background: Socioeconomic status (SES) is a key determinant of cancer outcomes, influencing access to screening, early diagnosis, treatment adherence, and survival. Socioeconomic disparities in breast cancer may contribute to differences in tumor biology, stage at diagnosis, and prognosis. Purpose: This study aimed to evaluate the impact of socioeconomic status on tumor stage at diagnosis, molecular subtype distribution, treatment utilization, adherence, and survival outcomes among patients with breast cancer. Methodology: A retrospective cohort study was conducted using hospital cancer registries and electronic medical records from a tertiary oncology center. A total of 800 patients diagnosed with primary invasive breast cancer were included and categorized into low (n = 300), middle (n = 300), and high (n = 200) SES groups based on income, education, and insurance status. Clinical and pathological variables were collected, including tumor stage, molecular subtype, treatment modalities, adherence patterns, and diagnostic delays. Survival outcomes were assessed using overall survival (OS) and disease-free survival (DFS) with a minimum follow-up of 72 months. Chi-square and ANOVA tests examined group differences, while multivariate logistic regression and Cox proportional hazards models identified predictors of late-stage diagnosis and survival outcomes. Results: Patients with low SES were significantly more likely to present with late-stage disease (49.3%) than those with high SES (25.0%) (p < 0.001). Low SES patients also showed more aggressive tumor characteristics, including larger tumor size, lymph node involvement, higher tumor grade, and elevated Ki-67 levels (p < 0.01). Triple-negative breast cancer was more prevalent in the low SES group (29.3%). Treatment adherence and completion rates were lower among low SES patients, accompanied by greater diagnostic and treatment delays. Survival analysis showed poorer outcomes in low SES patients, with reduced median OS (64 vs. 88 months) and DFS (50 vs. 80 months). Multivariate analysis confirmed low SES as an independent predictor of late-stage diagnosis (OR 2.45) and poorer survival (HR 1.72 for OS; HR 1.60 for DFS). Conclusion: Socioeconomic disparities significantly influence breast cancer stage at diagnosis, tumor characteristics, treatment adherence, and survival. Addressing socioeconomic barriers and improving equitable access to cancer care are essential to reduce disparities in breast cancer outcomes.
Li et al. (Fri,) studied this question.