Limits...
Social determinants of breast cancer in the Caribbean: a systematic review

View Article: PubMed Central - PubMed

ABSTRACT

Background: Breast cancer is the leading cause of cancer deaths among women in the Caribbean and accounts for >1 million disability adjusted life years. Little is known about the social inequalities of this disease in the Caribbean. In support of the Rio Political Declaration on addressing health inequities, this article presents a systematic review of evidence on the distribution, by social determinants, of breast cancer risk factors, frequency, and adverse outcomes in Caribbean women.

Methods: MEDLINE, EMBASE, SciELO, CINAHL, CUMED, LILACS, and IBECS were searched for observational studies reporting associations between social determinants and breast cancer risk factors, frequency, or outcomes. Based on the PROGRESS-plus checklist, we considered 8 social determinant groups for 14 breast cancer endpoints, which totalled to 189 possible ways (‘relationship groups’) to explore the role of social determinants on breast cancer. Studies with >50 participants conducted in Caribbean territories between 2004 and 2014 were eligible for inclusion. The review was conducted according to STROBE and PRISMA guidelines and results were planned as a narrative synthesis, with meta-analysis if possible.

Results: Thirty-four articles were included from 5,190 screened citations. From these included studies, 75 inequality relationships were reported examining 30 distinct relationship groups, leaving 84% of relationship groups unexplored. Most inequality relationships were reported for risk factors, particularly alcohol and overweight/obesity which generally showed a positive relationship with indicators of lower socioeconomic position. Evidence for breast cancer frequency and outcomes was scarce. Unmarried women tended to have a higher likelihood of being diagnosed with breast cancer when compared to married women. While no association was observed between breast cancer frequency and ethnicity, mortality from breast cancer was shown to be slightly higher among Asian-Indian compared to African-descent populations in Trinidad (OR 1.2, 95% CI 1.1–1.4) and Guyana (OR 1.3, 95% CI 1.0–1.6).

Conclusion: Study quantity, quality, and variability in outcomes and reporting limited the synthesis of evidence on the role of social determinants on breast cancer in the Caribbean. This report represents important current evidence on the region, and can guide future research priorities for better describing and understanding of Caribbean breast cancer inequalities.

Electronic supplementary material: The online version of this article (doi:10.1186/s12939-017-0540-z) contains supplementary material, which is available to authorized users.

No MeSH data available.


Summary of 75 inequality relationships from 34 articles between a social determinant and review endpoint [40–70, 72, 73]. Legend: Age and limited breastfeeding cells do not separate youth and adult samples as the studies have combined these age groups in their samples
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
getmorefigures.php?uid=PMC5382386&req=5

Fig2: Summary of 75 inequality relationships from 34 articles between a social determinant and review endpoint [40–70, 72, 73]. Legend: Age and limited breastfeeding cells do not separate youth and adult samples as the studies have combined these age groups in their samples

Mentions: Included articles reported on studies conducted in English-speaking (Antigua, Bahamas, Barbados, British Virgin Islands, Dominica, Grenada, Guyana, Jamaica, St. Lucia, Trinidad and Tobago, United States Virgin Islands); French-speaking (Guadeloupe); Dutch-speaking (Bonaire, St. Eustatius, Saba, Suriname); and Spanish-speaking (Cuba, Puerto Rico) territories. Most studies originated in Cuba (n = 7) and Jamaica (n = 7). Across the 8 categories of social determinants, there were a total of 15 different social determinants and 14 review endpoints, leaving 189 possible inequality relationship groups that could have been reported (Fig. 2). Only 30 (16%) of these relationship groups were reported by the 34 articles, leaving 159 relationship groups (84%) without an evidence base. There were 75 inequality relationships reported: 59 on breast cancer risk factors, 13 on breast cancer frequency, and 3 on breast cancer outcomes.Fig. 2


Social determinants of breast cancer in the Caribbean: a systematic review
Summary of 75 inequality relationships from 34 articles between a social determinant and review endpoint [40–70, 72, 73]. Legend: Age and limited breastfeeding cells do not separate youth and adult samples as the studies have combined these age groups in their samples
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC5382386&req=5

Fig2: Summary of 75 inequality relationships from 34 articles between a social determinant and review endpoint [40–70, 72, 73]. Legend: Age and limited breastfeeding cells do not separate youth and adult samples as the studies have combined these age groups in their samples
Mentions: Included articles reported on studies conducted in English-speaking (Antigua, Bahamas, Barbados, British Virgin Islands, Dominica, Grenada, Guyana, Jamaica, St. Lucia, Trinidad and Tobago, United States Virgin Islands); French-speaking (Guadeloupe); Dutch-speaking (Bonaire, St. Eustatius, Saba, Suriname); and Spanish-speaking (Cuba, Puerto Rico) territories. Most studies originated in Cuba (n = 7) and Jamaica (n = 7). Across the 8 categories of social determinants, there were a total of 15 different social determinants and 14 review endpoints, leaving 189 possible inequality relationship groups that could have been reported (Fig. 2). Only 30 (16%) of these relationship groups were reported by the 34 articles, leaving 159 relationship groups (84%) without an evidence base. There were 75 inequality relationships reported: 59 on breast cancer risk factors, 13 on breast cancer frequency, and 3 on breast cancer outcomes.Fig. 2

View Article: PubMed Central - PubMed

ABSTRACT

Background: Breast cancer is the leading cause of cancer deaths among women in the Caribbean and accounts for >1 million disability adjusted life years. Little is known about the social inequalities of this disease in the Caribbean. In support of the Rio Political Declaration on addressing health inequities, this article presents a systematic review of evidence on the distribution, by social determinants, of breast cancer risk factors, frequency, and adverse outcomes in Caribbean women.

Methods: MEDLINE, EMBASE, SciELO, CINAHL, CUMED, LILACS, and IBECS were searched for observational studies reporting associations between social determinants and breast cancer risk factors, frequency, or outcomes. Based on the PROGRESS-plus checklist, we considered 8 social determinant groups for 14 breast cancer endpoints, which totalled to 189 possible ways (‘relationship groups’) to explore the role of social determinants on breast cancer. Studies with >50 participants conducted in Caribbean territories between 2004 and 2014 were eligible for inclusion. The review was conducted according to STROBE and PRISMA guidelines and results were planned as a narrative synthesis, with meta-analysis if possible.

Results: Thirty-four articles were included from 5,190 screened citations. From these included studies, 75 inequality relationships were reported examining 30 distinct relationship groups, leaving 84% of relationship groups unexplored. Most inequality relationships were reported for risk factors, particularly alcohol and overweight/obesity which generally showed a positive relationship with indicators of lower socioeconomic position. Evidence for breast cancer frequency and outcomes was scarce. Unmarried women tended to have a higher likelihood of being diagnosed with breast cancer when compared to married women. While no association was observed between breast cancer frequency and ethnicity, mortality from breast cancer was shown to be slightly higher among Asian-Indian compared to African-descent populations in Trinidad (OR 1.2, 95% CI 1.1–1.4) and Guyana (OR 1.3, 95% CI 1.0–1.6).

Conclusion: Study quantity, quality, and variability in outcomes and reporting limited the synthesis of evidence on the role of social determinants on breast cancer in the Caribbean. This report represents important current evidence on the region, and can guide future research priorities for better describing and understanding of Caribbean breast cancer inequalities.

Electronic supplementary material: The online version of this article (doi:10.1186/s12939-017-0540-z) contains supplementary material, which is available to authorized users.

No MeSH data available.