Social marginalization and primary care gaps linked to early mortality in metastatic breast cancer
A study of 4,004 Ontario patients with de novo metastatic breast cancer found that 23% died within six months of diagnosis. Those who were marginalized or lacked a primary care provider faced a higher risk of early death. The research used ICES data from 2010 to 2019 and was published in the Canadian Medical Association Journal.
The Ontario analysis examined 4,004 people diagnosed with stage IV breast cancer that had already spread at detection, using ICES records from 2010 through 2019. Nearly one quarter died within half a year. Older patients, those with other illnesses, and those facing greater housing or income disadvantage had elevated risk.
Having a family doctor was tied to 26% lower odds of dying soon after diagnosis and greater likelihood of recent mammography. Rural residency also appeared linked to early death, possibly because treatment often requires travel to urban cancer centers. In Canada, about one in four people lack regular primary care.
The findings may prompt clinicians and health systems to consider social circumstances and primary care access when interpreting prognosis after metastatic breast cancer diagnosis. Patients without a regular provider, those facing housing or income marginalization, and rural residents could be especially affected if barriers delay diagnosis or treatment. Better connection to primary care might improve timeliness of screening and supportive care, though the study cannot prove causation.