CoChat
Sign Up
Cited by 530Global Cancer Incidence and ScreeningHealth disparities and outcomesPublic Health and Social Inequalities

Understanding and addressing social determinants to advance cancer health equity in the United States: A blueprint for practice, research, and policy

Open access
Alcaraz, Kassandra I., Wiedt, Tracy L., Daniels, Elvan C., Yabroff, K. Robin, Guerra, Carmen E., Wender, Richard C.·2020·CA: A Cancer Journal for Clinicians
DOI 10.3322/caac.21586
Open this paper in CoChat — free accountOpen PDF

Abstract

Although cancer mortality rates declined in the United States in recent decades, some populations experienced little benefit from advances in cancer prevention, early detection, treatment, and survivorship care. In fact, some cancer disparities between populations of low and high socioeconomic status widened during this period. Many potentially preventable cancer deaths continue to occur, and disadvantaged populations bear a disproportionate burden. Reducing the burden of cancer and eliminating cancer‐related disparities will require more focused and coordinated action across multiple sectors and in partnership with communities. This article, part of the American Cancer Society's Cancer Control Blueprint series, introduces a framework for understanding and addressing social determinants to advance cancer health equity and presents actionable recommendations for practice, research, and policy. The article aims to accelerate progress toward eliminating disparities in cancer and achieving health equity.

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.3322/caac.21586

Cites

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Individuals who identify with a racial or ethnic minority experience disparities in cancer outcomes, including later stage diagnosis, lower likelihood of receiving recommended treatment, lower likelihood of receiving high-quality diagnostic evaluation, lower likelihood of a provider referral for mammography, lower likelihood of timely follow-up after an abnormal screening test, and higher cancerm

    “individuals who identify with a racial or ethnic minority experience: (1) later stage diagnosis; (2) lower likelihood of receiving recommended treatment; (3) lower likelihood of receiving high-quality diagnostic evaluation; (4) lower likelihood of a provider referral for mammography; (5) lower likelihood of a timely follow-up after an abnormal screening test; or (6) higher cancer mortality2.”

    From Documentation of individual-level social determinants of health among adults diagnosed with cancer in the United States (2025) · cites this paper as [2]

    The Economic environment section reports later-stage diagnosis and higher cancer mortality among socioeconomically disadvantaged people, while Improve access to high-quality care describes inequitable access to timely, high-quality diagnosis and treatment among disadvantaged populations. These passages do not establish the six listed disparities specifically for racial or ethnic minority individuals. The paper also does not document lower rates of recommended treatment, mammography referral, or timely follow-up after an abnormal screening test for that group. (LLM, conf=0.82)

    Experimental — accuracy not yet measured

  • Awareness of the impacts of SDOH on health outcomes is evident from the oncology literature, largely due to the persistent disparities, substantial barriers to treatment, and the financial toxicity commonly associated with cancer care.

    “Awareness of the impacts of SDOH on health outcomes is evident from the oncology literature, largely due to the persistent disparities, substantial barriers to treatment, and the financial toxicity commonly associated with cancer care1,2,8,9,18.”

    From Documentation of individual-level social determinants of health among adults diagnosed with cancer in the United States (2025) · cites this paper as [2]

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

The citation lists haven’t been fetched yet

References 161 · Cited by 530

Part of this paper’s reference list could not be split into single entries.

Research works printed but not linked: 73

  1. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2019. CA Cancer J Clin. 2019; 69:7-34.
  2. Bronfenbrenner U. Toward an experi- mental ecology of human development. Am Psychol. 1977;32:513-531.
  3. McGinnis JM, Williams-Russo P, Knickman JR. The case for more active policy attention to health promotion. Health Affairs (Millwood). 2002;21:78-93.
  4. Remington PL, Catlin BB, Gennuso KP. The County Health Rankings: ratio- nale and methods. Popul Health Metr. 2015;13:11.
  5. Krieger N. Health equity and the fallacy of treating causes of population health as if they sum to 100. Am J Public Health. 2017;107:541-549.
  6. Hall KL, Oh A, Perez LG, et al. The ecol- ogy of multilevel intervention research. Transl Behav Med. 2018;8:968-978.
  7. Alderwick H, Gottlieb LM. Meanings and misunderstandings: a social deter- minants of health lexicon for health care systems. Milbank Q. 2019;97:407-419.
  8. Baciu A, Negussie Y, Geller A, Weinstein JN, eds. Communities in Action: Pathways to Health Equity. The National Academies Press; 2017.
  9. Siegel RL, Jemal A, Wender RC, Gansler T, Ma J, Brawley OW. An assessment of progress in cancer control. CA Cancer J Clin. 2018;68:329-339.
  10. Gapstur SM, Drope JM, Jacobs EJ, et al. A blueprint for the primary prevention of cancer: targeting established, mod- ifiable risk factors. CA Cancer J Clin. 2018;68:446-470.
  11. Wender RC, Brawley OW, Fedewa SA, Gansler T, Smith RA. A blueprint for cancer screening and early detection: advancing screening's contribution to cancer control. CA Cancer J Clin. 2019;69: 50-79.
  12. Yabroff KR, Gansler T, Wender RC, Cullen KJ, Brawley OW. Minimizing the burden of cancer in the United States: goals for a high-performing health care system. CA Cancer J Clin. 2019;69:166-183.
  13. Ma J, Jemal A, Fedewa SA, et al. The American Cancer Society 2035 challenge goal on cancer mortality reduction. CA Cancer J Clin. 2019;69:351-362.
  14. Office of Disease Prevention and Health Promotion, US Department of Health and Human Services. Healthy People CA: A Cancer Journal for Clinicians 2020: Social Determinants of Health. US Department of Health and Human Services; 2018. Accessed November 10, 2018. healt hypeo ple.gov/2020/topics- objec tives/ topic/ social-deter minan ts-of- healt h#five
  15. Holt-Lunstad J, Smith TB. Loneliness and social isolation as risk factors for CVD: implications for evidence-based patient care and scientific inquiry. Heart. 2016;102:987-989.
  16. Warnecke RB, Oh A, Breen N, et al. Approaching health disparities from a population perspective: the National Institutes of Health Centers for Population Health and Health Disparities. Am J Public Health. 2008;98:1608-1615.
  17. National Academies of Sciences, Engi- neering, and Medicine; Roundtable on Population Health Improvement. Exploring Equity in Multisector Commu- nity Health Partnerships: Proceedings of a Workshop. Washington, DC: The National Academies Press; 2017.
  18. Pallok K, De Maio F, Ansell DA. Structural racism-a 60-year-old black woman with breast cancer. N Engl J Med. 2019;380:1489-1493.
  19. Luchenski S, Maguire N, Aldridge RW, et al. What works in inclusion health: overview of effective interventions for marginalised and excluded populations. Lancet. 2018;391:266-280.
  20. Krieger N. Embodying inequality: a review of concepts, measures, and meth- ods for studying health consequences of discrimination. Int J Health Serv. 1999;29:295-352.
  21. Pincus FL. Discrimination comes in many forms: individual, institutional and structural. Am Behav Sci. 1996;40: 186-194.
  22. Williams DR, Collins C. Racial residen- tial segregation: a fundamental cause of racial disparities in health. Public Health Rep. 2001;116:404-416.
  23. Landrine H, Corral I, Lee JGL, Efird JT, Hall MB, Bess JJ. Residential segre- gation and racial cancer disparities: a systematic review. J Racial Ethn Health Disparities. 2017;4:1195-1205.
  24. Zajacova A, Lawrence EM. The rela- tionship between education and health: reducing disparities through a contex- tual approach. Ann Rev Public Health. 2018;39:273-289.
  25. Cole MB, Galarraga O, Wilson IB, Wright B, Trivedi AN. At federally funded health centers, Medicaid expansion was asso- ciated with improved quality of care. Health Aff (Millwood). 2017;36:40-48.
  26. Sundar KR. Universal screening for social needs in a primary care clinic: a quality improvement approach using the Your Current Life Situation Survey. Perm J. 2018;22:18-089.
  27. Berkowitz SA, Baggett TP, Edwards ST. Addressing health-related social needs: value-based care or values-based care? J Gen Intern Med. 2019;34:1916-1918.
  28. Garg A, Cull W, Olson L, et al. Screening and referral for low-income families' social determinants of health by US pediatricians. Published online May 23, 2019. Acad Pediatr. doi:10.1016/j. acap.2019.05.125 · DOI
  29. Lundeen EA, Siegel KR, Calhoun H, et al. Clinical-community partnerships to identify patients with food insecurity and address food needs. Prev Chronic Dis. 2017;14:E113.
  30. Castrucci B, Auerbach J. Meeting indi- vidual social needs falls short of address- ing social determinants of health. Health Affairs; 2019. Accessed February 19, 2019. healt haffa irs.org/do/10.1377/hblog 20190 115.23494 2/full/ · DOI
  31. Singh GK, Jemal A. Socioeconomic and racial/ethnic disparities in cancer mortality, incidence, and survival in the United States, 1950-2014: over six decades of changing patterns and widen- ing inequalities. J Environ Public Health. 2017;2017:2819372.
  32. Boscoe FP, Henry KA, Sherman RL, Johnson CJ. The relationship between cancer incidence, stage and poverty in the United States. Int J Cancer. 2016; 139:607-612.
  33. Zafar SY, Abernethy AP. Financial toxic- ity, part I: a new name for a growing prob- lem. Oncology (Williston Park). 2013; 27:80-81, 149.
  34. Demark-Wahnefried W, Rogers LQ, Alfano CM, et al. Practical clinical inter- ventions for diet, physical activity, and weight control in cancer survivors. CA Cancer J Clin. 2015;65:167-189.
  35. Rogers LQ, Carter SJ, Williams G, Courneya KS. Physical activity. In: Feuerstein M, Nekhlyudov L, eds. Hand- book of Cancer Survivorship. Springer; 2018:287-307.
  36. Hawes AM, Smith GS, McGinty E, et al. Disentangling race, poverty, and place in disparities in physical activity. Int J Environ Res Public Health. 2019; 16:E1193.
  37. Hilmers A, Hilmers DC, Dave J. Neighborhood disparities in access to healthy foods and their effects on envi- ronmental justice. Am J Public Health. 2012;102:1644-1654.
  38. Ver Ploeg M, Mancino L, Todd JE, Clay DM, Schara B. Economic Information Bulletin 138. Where Do Americans Usually Shop for Food and How Do They Travel To Get There? Initial Findings From the National Household Food Acquisition and Purchase Survey. US Department of Agriculture, Economic Research Service; 2015. VOLUME 70 | NUMBER 1 | JANUARY/FEBRUARY 2020
  39. Powell LM, Slater S, Mirtcheva D, Bao Y, Chaloupka FJ. Food store availability and neighborhood characteristics in the United States. Prev Med. 2007; 44:189-195.
  40. Powell LM, Wada R, Kumanyika SK. Racial/ethnic and income disparities in child and adolescent exposure to food and beverage television ads across the U.S. media markets. Health Place. 2014;29:124-131.
  41. Diez Roux AV, Mair C. Neighborhoods and health. Ann N Y Acad Sci. 2010; 1186:125-145.
  42. Gordon-Larsen P, Nelson MC, Page P, Popkin BM. Inequality in the built environment underlies key health dis- parities in physical activity and obesity. Pediatrics. 2006;117:417-424.
  43. Powell LM, Slater S, Chaloupka FJ, Harper D. Availability of physical activity-related facilities and neighbor- hood demographic and socioeconomic characteristics: a national study. Am J Public Health. 2006;96:1676-1680.
  44. Holben DH; American Dietetic Association. Position of the American Dietetic Association: food insecurity in the United States. J Am Diet Assoc. 2010; 110:1368-1377.
  45. Bengle R, Sinnett S, Johnson T, Johnson MA, Brown A, Lee JS. Food insecurity is associated with cost-related medication non-adherence in community-dwelling, low-income older adults in Georgia. J Nutr Elder. 2010;29:170-191.
  46. Landrigan PJ. Asbestos-still a carcino- gen. N Engl J Med. 1998;338:1618-1619.
  47. Field RW. A review of residential radon case-control epidemiologic studies per- formed in the United States. Rev Environ Health. 2001;16:151-167.
  48. Frederick TJ, Chwalek M, Hughes J, Karabanow J, Kidd S. How stable is sta- ble? Defining and measuring housing stability. J Community Psychol. 2014; 42:964-979.
  49. Kushel MB, Gupta R, Gee L, Haas JS. Housing instability and food insecurity as barriers to health care among low-in- come Americans. J Gen Intern Med. 2006;21:71-77.
  50. Asgary R. Cancer screening in the home- less population. Lancet Oncol. 2018; 19:e344-e350.
  51. Cornwell B. Social disadvantage and net- work turnover. J Gerontol B Psychol Sci Soc Sci. 2015;70:132-142.
  52. Granovetter MS. The strength of weak ties. Am J Sociol. 1973;78:1360-1380.
  53. Alcaraz KI, Eddens KS, Blase JL, et al. Social isolation and mortality in US black and white men and women. Am J Epidemiol. 2019;188:102-109.
  54. Shankar A, McMunn A, Banks J, Steptoe A. Loneliness, social isolation, and behavioral and biological health indi- cators in older adults. Health Psychol. 2011;30:377-385.
  55. Yang YC, Boen C, Gerken K, Li T, Schorpp K, Harris KM. Social relationships and physiological determinants of longevity across the human life span. Proc Natl Acad Sci U S A. 2016;113:578-583.
  56. Berkman LF, Melchior M, Chastang JF, Niedhammer I, Leclerc A, Goldberg M. Social integration and mortality: a prospective study of French employees of Electricity of France-Gas of France: the GAZEL cohort. Am J Epidemiol. 2004;159:167-174.
  57. Reynolds P, Kaplan GA. Social connec- tions and risk for cancer: prospective evidence from the Alameda County Study. Behav Med. 1990;16:101-110.
  58. Miller B, Rote SM, Keith VM. Coping with racial discrimination: assessing the vulnerability of African Americans and the mediated moderation of psy- chosocial resources. Soc Ment Health. 2013;3:133-150.
  59. Purnell JQ, Peppone LJ, Alcaraz K, et al. Perceived discrimination, psychological distress, and current smoking status: results from the Behavioral Risk Factor Surveillance System Reactions to Race module, 2004-2008. Am J Public Health. 2012;102:844-851.
  60. Sims M, Diez-Roux AV, Gebreab SY, et al. Perceived discrimination is asso- ciated with health behaviours among African-Americans in the Jackson Heart Study. J Epidemiol Community Health. 2016;70:187-194.
  61. Slopen N, Lewis TT, Williams DR. Discrimination and sleep: a systematic review. Sleep Med. 2016;18:88-95.
  62. Jacobs EA, Rathouz PJ, Karavolos K, et al. Perceived discrimination is associated with reduced breast and cervical cancer screening: the Study of Women's Health Across the Nation (SWAN). J Womens Health (Larchmt). 2014;23:138-145.
  63. Williams DR, Mohammed SA. Racism and health I: pathways and scientific evidence. Am Behav Sci. 2013;57:8. doi:10.1177/00027 64213 487340 · DOI · Paper page
  64. Harrell JP, Hall S, Taliaferro J. Physiological responses to racism and discrimination: an assessment of the evidence. Am J Public Health. 2003;93: 243-248.
  65. Henley SJ, Anderson RN, Thomas CC, Massetti GM, Peaker B, Richardson LC. Invasive cancer incidence, 2004-2013, and deaths, 2006-2015, in nonmetropol- itan and metropolitan counties-United States. MMRW Surveill Summ. 2017;66: 1-13.
  66. Wallace R, Hughes-Cromwick P, Mull H, Khasnabis S. Access to health care and nonemergency medical transportation: two missing links. Transportation Res Record. 2005;1924:76-84.
  67. CA: A Cancer Journal for Clinicians
  68. Syed ST, Gerber BS, Sharp LK. Traveling towards disease: transportation barri- ers to health care access. J Community Health. 2013;38:976-993.
  69. Finkelhor D, Shattuck A, Turner H, Hamby S. Improving the adverse child- hood experiences study scale. JAMA Pediatr. 2013;167:70-75.
  70. Meyer OL, Castro-Schilo L, Aguilar- Gaxiola S. Determinants of mental health and self-rated health: a model of socioeconomic status, neighborhood safety, and physical activity. Am J Public Health. 2014;104:1734-1741.
  71. Han X, Yabroff KR, Ward E, Brawley OW, Jemal A. Comparison of insurance status and diagnosis stage among patients with newly diagnosed cancer before vs after implementation of the Patient Protection and Affordable Care Act. JAMA Oncol. 2018;4:1713-1720. 139. Jemal A, Lin CC, Davidoff AJ, Han X. Changes in insurance coverage and stage at diagnosis among nonelderly patients with cancer after the Affordable Care Act. J Clin Oncol. 2017;35:3906-3915. 140. Soni A, Sabik LM, Simon K, Sommers BD. Changes in insurance coverage among cancer patients under the Affordable Care Act. JAMA Oncol. 2018;4:122-124. 141. Soni A, Simon K, Cawley J, Sabik L. Effect of Medicaid expansions of 2014 on overall and early-stage cancer diagnoses. Am J Public Health. 2018;108:216-218. 142. NORC at the University of Chicago. Understanding the Impact of Health IT in Underserved Communities and Those With Health Disparities. Office of the National Coordinator for Health Information Technology, Department of Health and Hyman Services; 2013. Accessed October 7, 2019. healt hit. gov/sites/ defau lt/files/ hit_dispa rities_ report_050713.pdf 143.
  72. Lyles C, Schillinger D, Sarkar U. Connecting the dots: health information technology expansion and health dispar- ities. PLoS Med. 2015;12:e1001852. 144. Tran C, Dicker AP, Jim HSL. The emerg- ing role of mobile health in oncol- ogy. J Target Ther Cancer. Accessed October 7, 2019. targe tedonc.com/ publi catio ns/targe ted-thera pies-cance r/ 2017/2017-june/the-emerg ing-role-of- mobile-health-in-oncology 145.
  73. Veinot TC, Mitchell H, Ancker JS. Good intentions are not enough: how informat- ics interventions can worsen inequality. J Am Inform Assoc. 2018;25:1080-1088. 146. Vaccarella S, Lortet-Tieulent J, Saracci R, Conway DI, Straif K, Wild CP, eds. Reducing Social Inequalities in Cancer: Evidence and Priorities for Research. IARC Scientific publication 168. International Agency for Research on Cancer; 2019. 147. Billioux A, Verlander K, Anthony S, Alley D. Standardized Screening for Health- Related Social Needs in Clinical Settings: The Accountable Health Communities Screening Tool. NAM Perspectives. Discussion Paper. National Academy of Medicine; 2017. Accessed October 8, 2019. nam.edu/wp-conte nt/uploa ds/2017/05/ Stand ardiz ed-Scree ning-for-Health-Relat ed-Social-Needs-in-Clini cal-Setti ngs.pdf 148. National Association of Community Health Centers. Protocol for Responding to and Assessing Patients' Assets, Risks, and Experiences (PRAPARE). National Association of Community Health Centers; 2016. Accessed July 1, 2019. nachc.org/resea rch-and-data/prapa re/ 149.

Authors
Alcaraz, K. I., Wiedt, T. L., Daniels, E. C., Yabroff, K. R., Guerra, C. E., & Wender, R. C.
Affiliations
  • American Cancer Society (US)
  • Abramson Cancer Center (US)
Corresponding author
Alcaraz, Kassandra I.
ORCID
Venue
CA: A Cancer Journal for Clinicians
Publisher
Wiley
Published
2019-10-29
Volume
70
Issue
1
Pages
31-46
ISSN
  • 0007-9235 (ISSN-L)
  • 1542-4863
DOI
10.3322/caac.21586
OpenAlex
W2982480504
Cited by
530
References
161
Citations by year
2026: 48 · 2025: 99 · 2024: 123 · 2023: 108 · 2022: 83 · 2021: 48 · 2020: 20
FWCI
3.59
Type
journal article
Language
en
Open access
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations
  • CA A Cancer Journal for Clinicians (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • Robert Wood Johnson Foundation
  • National Cancer Institute
Topics
  • Health Sciences › Medicine › Oncology › Global Cancer Incidence and Screening
  • Social Sciences › Health › Health disparities and outcomes
  • Social Sciences › Health › Public Health and Social Inequalities
Keywords
social determinants of health, cancer health equity, cancer disparities, socioeconomic status, cancer prevention, survivorship care, cancer control policy, community partnerships, health equity frameworks
MeSH terms
Health Equity, Combined Modality Therapy, Health Policy, Humans, Morbidity, Neoplasms, Global Health, Survival Rate, Health Status Disparities, Social Determinants of Health

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review