Socioeconomic Factors

As previously stated, the California Cancer Registry calculates socioeconomic status by census block group rather than by individuals, and reports it in quintiles, with SES 1 being the poorest and SES 5 being the most affluent. The most recent data from November 2002, show that socio-economic status is a predictor for fiveyear relative survival, within each racial/ethnic group.

A recent study of socio-economic status and breast cancer survival in the Greater San Francisco Bay area between 1988–199256 sought to broaden the understanding of disparities in two other racial/ethnic groups, Hispanics and Asian women. This study found that tenyear unadjusted (all mortality) survival rates for breast cancer patients were 81 percent for whites, 69 percent for blacks, 75 percent for Hispanics, and 79 percent for Asians. When they adjusted the statistics to account for differences in stage, they found that Asians and Hispanics showed no significant difference from whites, while for black women there was still a disparity, with a persistent relative risk of 1.29, down from 1.81 before stage adjustment. While other factors did not further reduce the relative risk, living in a blue-collar neighborhood was found to be independently associated with a 1.16 increase in mortality.

A thoughtful 2002 review of socio-economic factors and breast cancer outcome cites previous research indicating that factors related to socio-economic concerns—such as child/family care, literacy/education levels and lack of transportation may contribute to non-compliance with recommended treatment and poorer outcomes.58

“Most researchers will agree that race is a surrogate measure of factors such as SES, access to health care, and cultural systems,” Sue Joslyn states, citing studies that show similarities in low-income and high-income survival rates, regardless of race. “Two hypotheses arise from these studies: (1) SES is the true causative factor in racial differences in survival or (2) the health experiences of African American women are different from that of white women.”