Social determinants of health and breast cancer surgical care trajectories in the United States

Abstract Social determinants of health (SDOH) profoundly shape breast cancer treatment pathways and outcomes. Variables such as race, socioeconomic status, and insurance coverage significantly influence the timeliness, accessibility, and quality of surgical care. This narrative review aims to critically examine how SDOH influences breast cancer surgical trajectories and outcomes in the United States. By synthesizing current epidemiological evidence, the review explores the impact of these non-medical factors on time to surgery, procedure selection, access to reconstruction, postoperative complications, and quality of life. Racial and socioeconomic disparities persist across the continuum of care, with marginalized populations experiencing greater delays, lower rates of breast-conserving surgery, and decreased access to reconstruction. Insurance status, particularly lack of private coverage, is consistently associated with inferior outcomes and reduced access to standard treatments. Despite the growing body of evidence, major clinical guidelines still fail to integrate SDOH into decision-making frameworks, underscoring the need for systemic changes to promote equitable care.