Table 1.
Study design, structural racism measures, and outcome measures.
| First author, year | Study design and data | Population and sample size | Measure of structural racism | Breast cancer outcomes |
|---|---|---|---|---|
| Beyer, 2016 (15) | Retrospective cohort, Milwaukee, Wisconsin cancer registry | Black/African American women diagnosed with breast cancer (n=1010) | Racial bias in mortgage lending and redlining using redlining index | Breast cancer survival among Black/African American women |
| Beyer, 2021 (16) | Retrospective cohort, SEER | Non-Hispanicwhite, Hispanic, and non-Hispanic Black women aged 66–90 years with an initial diagnosis of stage I-IV breast cancer (n=27,516) | Redlining index | Survival among older women with breast cancer |
| Bikomeye, 2023 (17) | Retrospective cohort, SEER | Women(n=18,119) | HOLC risk grade | receipt of various cancer treatments, all-cause mortality (ACM), and BC-specific mortality (BCSM) |
| Bonner, 2019 (36) | Cross sectional, population-based sample | Black, Hispanic, and white women in Northern California with stage I to III breast cancer diagnosed (n=500) | Location quotient (LQ) of residential segregation | receiving guideline-recommended adjuvant therapy and patient knowledge of tumor characteristics |
| Canales, 2023 (18) | Retrospective cohort, SEER | Non-Hispanic Black women aged 66–90 years with an initial diagnosis of stage I-IV BC (n=5,231) | Local LEx/Is and MSA measures of isolation | Survival among older non-Hispanic (NH) Black women with breast cancer (BC) |
| Collin, 2021 (19) | Retrospective cohort, Georgia Cancer Registry data | Non-Hispanic white (n=4,943) and Non-Hispanic Black (n=3,580) women with a first primary invasive breast cancer | Redlining index | breast cancer mortality |
| Dai, 2010 (37) | Cross sectional, Michigan Cancer Surveillance Program. | Women consisting of 68.9% whites, 25% Blacks, and 6.1% of other minorities (n=4,043,467) | Isolation index | Late-stage diagnosis of breast cancer |
| Eldridge, 2022 (20) | Retrospective cohort, SEER, 12 states represented in the data set were California, Connecticut, Georgia, Hawaii, Iowa, Kentucky, Louisiana, Michigan, New Mexico, New Jersey, Washington, and Utah. | Non-Hispanic white women (n=301,600) and non-Hispanic Black women (n=46,853) | Black to white rate ratios in educational attainment, political participation, incarceration, and unemployment; and dichotomized to “high” or “low” structural racism using the median rate ratio of the 12 states | Incidence of triple-negative breast cancer (TNBC) |
| Goel, 2022 (21) | Retrospective cohort, Local Cancer registry in south Florida | Non-Hispanic Black and Non-Hispanic white women with breast cancer(N=5909) | Index of concentration at extreme (ICE) | Breast Cancer Specific Survival |
| Haas, 2008 (38) | Cross sectional, Surveillance, Epidemiology, and End Results (SEER) | Black and white women aged 66 to 85 years diagnosed with stage I, II, or IIIA breast cancer (n= 70,541) | Isolation index | Receipt of adequate breast cancer care |
| Krieger, 2016 (39) | Cross sectional, US Surveillance, Epidemiology, and End Results (SEER) program. | Black and white women aged 25–84 who were diagnosed with primary invasive breast cancer (n= 516,382) | Index of Concentration at the Extremes (ICE). | ER+ve breast cancer |
| Krieger, 2020 (22) | Retrospective cohort, Massachusetts cancer registry | Non-Hispanic white and Non-Hispanic Black breast cancer women (n= 20,808) | HOLC risk grade | Late stage at presentation |
| Lubarsky, 2024 (31) | Retrospective cohort, Two medical centers in Miami | (n=5173) | Index of concentration at Extreme | Receipt of receipt of National Cancer Center Network (NCCN) guideline-concordant breast cancer treatment |
| Michaels, 2022 (34) | Retrospective cohort, California Cancer Registry | Women with primary invasive breast cancer (n=118,381) | Racial bias in mortgage lending | Incidence of luminal A and TNBC |
| Miller-Kleinhenz, 2024 (43) | Cohort, Georgia Cancer registry | Women diagnosed with breast cancer (n=1764) | Redlining index, persistent mortgage discrimination using both contemporary mortgage discrimination and redlining scores | ER status, late stage at diagnosis, BC-specific death |
| Miller-Kleinhenz, 2023 (23) | Retrospective cohort, Georgia Cancer registry, 80 NHB and NHW women diagnosed with stage I to III breast cancer | Non-Hispanic white (n=17) and Non-Hispanic Black (n=63) women diagnosed with BC | Redlining index | DNA methylation in breast tumor tissue |
| Moss, 2019 (40) | Cross sectional, National Cancer Institute’s Health Information National Survey | Non-Hispanic white and other races (n=17 736) | Dissimilarity index (DI) | Breast cancer screening |
| Nabi, 2024 (33) | Retrospective cohort, SEER | Non-Hispanic Black and white women with Ductal carcinoma in situ (DCIS) (n=103,898) | Index of concentration at Extreme | Mortality and mastectomy and radiotherapy |
| Ojinnaka, 2017 (24) | Retrospective study, Texas Cancer Registry | Black, white, Hispanic and non-Hispanic women with breast cancer(n=69,824) | Isolation index | Using Mastectomy/Breast Conservation Therapy |
| Oka, 2022 (41) | Cross sectional, Tennessee Cancer Registry (TCR) | Non-Hispanic white (n=46,983) Non-Hispanic Black (n=7,967) diagnosed with a non-invasive or invasive breast cancer |
Isolation index of P* | Breast cancer condition (invasive/non-invasive) |
| Pittell, 2024 (32) | Retrospective cohort, Flatiron Health electronic health record (EHR) | Women with metastatic breast cancer (n=27,459) | Index of concentration at Extreme Secondary: Yost Index % of Black Structural Racism Indicator |
Overall survival and time to treatment initiation |
| Plascak, 2021 (42) | Prospective Cohort, questionnaire to patients from New Jersey State Cancer Registry | Black breast cancer survivors (n = 476) | Gini and Isolation indices | Breast cancer reported levels of stress |
| Plascak, 2022 (25) | Retrospective cohort study, New Jersey State Cancer Registry women with breast cancer | Latina (n=2869) Non-Latina Black (n=3506) Non-Latina white (n=7686) Other (n=1083) women with breast cancer |
HOLC risk grade | Late stage at diagnosis, high tumor grade, triple-negative subtype (lacking estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2 expression), breast cancer–specific death. |
| Poulson, 2021 (26) | retrospective cohort study, SEER | Black and white patients diagnosed with invasive breast cancer, 100 most populous participating counties | The racial index of dissimilarity | advanced stage at diagnosis (stage III/IV), surgery for localized disease (stage I/II), and overall stage-specific survival |
| Pruitt, 2015 (27) | Retrospective cohort, Texas cancer registry | Black, Hispanic and white women (n=109,749) | Location quotient of residential racial segregation (LQ) measure | mortality among breast cancer patients |
| Reeder-Hayes, 2024 (35) | Retrospective cohort, North Carolina Central Cancer Registry | Women with stage I-III BC (n=32,095) | Structural racism composite score from eight SDOH across five domains | Treatment delay |
| Russell, 2012 (28) | Retrospective cohort, Georgia Comprehensive Cancer Registry (GCCR) | Black and white women diagnosed with breast cancer (n = 22,088) | Theil’s Information Theory Index (H index) | breast cancer and all-cause mortality among Black and white breast cancer patients |
| Warner, 2010 (29) | Retrospective cohort, California Cancer Registry (CCR), | Black (n=10,030) and white (n=113,979) women in California | Dissimilarity, delta, isolation, relative centralization, and spatial proximity indices. | all-cause and breast cancer-specific survival between and within Black and white women diagnosed with breast cancer |
| Wright, 2022 (30) | Retrospective cohort, Massachusetts cancer registry | Black, Hispanic, white non-Hispanic, Asian or Pacific Islander, American Indian or Alaska Native, and other racial groups of breast cancer patients (n=60,173) | HOLC risk grade | Breast cancer Incidence |