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Am J Public Health. 2015 Jul;105 Suppl 3:e4-e15. doi: 10.2105/AJPH.2014.302490. Epub 2015 Apr 23.

Racial/Ethnic and socioeconomic disparities in endocrine therapy adherence in breast cancer: a systematic review.

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Megan C. Roberts, Stephanie B. Wheeler, and Katherine Reeder-Hayes are with the Lineberger Comprehensive Cancer Center, University of North Carolina (UNC), Chapel Hill. Megan C. Roberts and Stephanie B. Wheeler are also with the Department of Health Policy and Management, Gillings School of Global Public Health, UNC, Chapel Hill. Katherine Reeder-Hayes is also with the Division of Hematology/Oncology, School of Medicine, UNC, Chapel Hill.


We examined the current literature to understand factors that influence endocrine therapy (ET) adherence among racial/ethnic and socioeconomic subpopulations of breast cancer patients. We searched PubMed and PsycINFO databases for studies from January 1, 1978, to June 20, 2014, and January 1, 1991, to June 20, 2014, respectively, and hand-searched articles from relevant literature reviews. We abstracted and synthesized results within a social ecological framework. Fourteen articles met all inclusion criteria. The majority of included articles reported significant underuse of ET among minority and low-income women. Modifiable intrapersonal, interpersonal, and community-level factors are associated with ET use, and these factors vary across subgroups. Both race/ethnicity and socioeconomic status are associated with ET use in most settings. Variation in factors associated with ET use across subgroups indicates the need for more nuanced research and targeted interventions among breast cancer patients.

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