The Impact of Social Determinants of Health on Breast Cancer Management Among Black Women: A Scoping Review

<title>Abstract</title> <p>Background Breast cancer is still one of the most commonly diagnosed malignancies in women globally; nonetheless, major disparities in breast cancer outcomes exist among Black women. Although biological factors contribute to disease progression, increasing evidence shows that social determinants of health (SDOH), such as socioeconomic status, healthcare access, racism, education, housing, and social support, have a significant impact on breast cancer prevention, diagnosis, treatment, and survivorship. Black women face particular challenges along the cancer care continuum, which are frequently driven by structural and systemic inequalities that limit timely access to quality, culturally relevant care. This scoping review sought to investigate how SDOH affects breast cancer management in Black women and to identify current gaps in the literature, particularly limited evidence from the Canadian context. Objective This scoping review aimed to systematically map the existing evidence on how social determinants of health influence breast cancer management among Black women across the care continuum, from screening to diagnosis, treatment, survivorship, and mortality. The review also aims to highlight research gaps and their consequences for clinical practice, health policy, and future research, focusing on the Canadian context. Methods A scoping review was conducted using the Joanna Briggs Institute (JBI) methodology and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) recommendations. A complete search was carried out using PubMed, CINAHL, Scopus and APA PsycINFO. 33 studies examining the association between SDOH and breast cancer management in Black women were considered. Covidence was used for both screening and data extraction. The included papers were examined thematically to find reoccurring barriers, facilitators, and gaps in breast cancer care experiences and results. Results Four overarching themes emerged from the literature. Healthcare access has frequently been highlighted as a major determinant of breast cancer outcomes, with hurdles to screening, specialist care, and timely treatment all leading to delays throughout the cancer care pathway. Socioeconomic characteristics such as income, education, and employment influenced access to healthcare resources, treatment options, and the ability to follow prescribed care. Structural racism, discrimination, and medical mistrust were also commonly cited as impediments to healthcare experiences, patient-provider relationships, and engagement with cancer care. Although the literature provided significant evidence of disparities experienced by Black women, the majority of studies were undertaken in the United States, with limited evidence investigating Black women's experiences in Canada. Conclusion This scoping study emphasizes the importance of social determinants of health in shaping breast cancer management for Black women. The findings show that gaps are driven by broader structural and social imbalances, not just individual-level issues. To address these gaps, strategies must be developed to improve equitable healthcare access, lower systemic barriers, and encourage culturally sensitive cancer care. Further Canadian research is needed in the Canadian healthcare system to better understand Black women's experiences and develop focused interventions that promote equitable breast cancer outcomes.</p>