The striking ethnic and racial disparities in breast cancer mortality are not explained fully by pathological or clinical features. Structural racism contributes to adverse conditions that promote cancer inequities, but the pathways by which this occurs are not fully understood. Social determinants of health (SDOH), such as economic status and access to care, account for a portion of this variability, yet interventions designed to mitigate these barriers have not consistently led to improved outcomes. Based on the current evidence from multiple disciplines, we describe a conceptual model in which structural racism and racial discrimination contribute to increased mortality risk in diverse groups of patients by promoting adverse SDOH that elevate exposure to environmental hazards and stress; these exposures in turn contribute to epigenetic and immune dysregulation, thereby altering breast cancer outcomes. Based on this model, opportunities and challenges arise for interventions to reduce racial and ethnic disparities in breast cancer mortality.

中文翻译：

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结构性种族主义和健康的社会决定因素对乳腺癌死亡率差异的影响


乳腺癌死亡率的显着种族差异并不能完全用病理或临床特征来解释。结构性种族主义会造成促进癌症不平等的不利条件，但这种情况发生的途径尚不完全清楚。健康的社会决定因素（SDOH），例如经济状况和获得护理的机会，是造成这种变化的部分原因，但旨在减轻这些障碍的干预措施并没有始终如一地带来改善的结果。基于来自多个学科的当前证据，我们描述了一个概念模型，其中结构性种族主义和种族歧视通过促进不利的 SDOH 增加暴露于环境危害和压力，从而导致不同患者群体的死亡风险增加；这些暴露反过来会导致表观遗传和免疫失调，从而改变乳腺癌的结果。基于这一模型，减少乳腺癌死亡率的种族和民族差异的干预措施出现了机遇和挑战。