We read with great interest the work by Stabellini et al1 on social determinants of health (SDOH) and racial disparities in cardiac events in breast cancer, recently published in JNCCN. The authors masterfully examined in women with breast cancer the impact of individual and neighborhood-level SDOH on the racial disparities in major adverse cardiovascular events (MACE). They concluded that the most important SDOH predictors for 2-year MACE are neighborhood and built environment variables, and that non-Hispanic Black patients were more likely to have unfavorable SDOH conditions.
Furthermore, in their accompanying commentary, Corianò et al2 emphasized that the study’s findings highlight the importance of social constructs and, due to the importance of the objectives set and the results obtained, suggested the need to broaden the scenarios in which to carry out these studies to make research more inclusive, and to ensure that study results are applicable to broader patient groups.
In this regard, sex and gender minorities represent a multiplicity of populations in which a particular vulnerability to cancer is widely documented,3 and unfortunately, many investigations reflect the invisibility of the LGBTQI+ population.4 Sadly there are significant disparities in the cardiovascular and oncologic health of these groups of people due to variety of causes, many of which are now well identified and described in several studies. However, the implementation of significant actions by the different players in the system to overcome these disparities and make health care truly inclusive is still lacking. Among the many, we recall some differences in the risk for some types of cancer within the LGBTQI+ population, cardiovascular health that could be undermined by greater exposure to traditional risk factors, greater difficulty in accessing treatment, the lack of specific data to support the personalization of care, a greater exposure to stressful factors, and the development of psychiatric conditions in turn capable of influencing the development and outcome of oncologic and cardiovascular diseases.5 Actionable strategies must be implemented within cardio-oncology research, clinical practice, and community engagement to reduce these disparities.
In conclusion, we hope that our reflections may offer additional topics to the discussion and contribute to sensitizing researchers, clinicians, and all possible actors involved on the need to broaden their perspective for truly inclusive research and care.
References
- 1.↑
Stabellini N, Dmukauskas M, Bittencourt MS, et al. Social determinants of health and racial disparities in cardiac events in breast cancer. J Natl Compr Canc Netw 2023;21:705–714.e17.
- 2.↑
Corianò M, Armillotta M, Battisti NML. Social determinants of health and cardiac risk for patients with breast cancer: beyond racial disparities. J Natl Compr Canc Netw 2023;21:783–784.
- 3.↑
Sirufo MM, Magnanimi LM, Ginaldi L, De Martinis M. Strategies to reduce health care disparities for sexual and gender minorities. Curr Probl Cancer 2023;47:100881.
- 4.↑
Scout N. Unique issues facing sexual and gender minorities in cancer. Cancer Discov 2023;13:1297–1300.
- 5.↑
Sirufo MM, Magnanimi LM, Ginaldi L, De Martinis M. Overcoming LGBTQI+ disparities in cardio-oncology: a call to action. JACC CardioOncol 2023;5:267–270.
