Evidence map›Paper›PMID 41149473›Full record

ArticleCurrent oncology (Toronto, Ont.)2025

Beyond Biology: Uncovering Structural and Sociocultural Predictors of Breast Cancer Incidence Worldwide.

Janet Diaz-Martinez, Gustavo A Hernández-Fuentes, Josuel Delgado-Enciso, Mario A Alcalá-Pérez, Isaac Jiménez-Calvo, Carmen A Sánchez-Ramírez, Fabian Rojas-Larios, Alejandrina Rodriguez-Hernandez, Mario Ramírez-Flores, José Guzmán-Esquivel and 4 more

Abstract read
In one paragraph

Article in Current oncology (Toronto, Ont.), 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

14 authors.

Janet Diaz-MartinezDepartment of Dietetics and Nutrition, Research Center in Minority Institutions, Florida International University (FIU-RCMI), Miami, FL 33199, USA.ORCID 0000-0003-3295-4768
Gustavo A Hernández-FuentesDepartment of Molecular Medicine, School of Medicine, University of Colima, Colima 28040, Mexico.ORCID 0000-0003-4685-3095
Josuel Delgado-EncisoFoundation for Ethics Education and Cancer Research of the IEC of Colima AC, Colima 28085, Mexico.
Mario A Alcalá-PérezMolecular Medicine Laboratory, Unidad de Medicina Humana y Ciencias de la Salud, Universidad Autónoma de Zacatecas, Zacatecas 98160, Mexico.ORCID 0009-0004-4505-7892
Isaac Jiménez-CalvoState Cancerology Institute of Colima, Health Services of the Mexican Social Security Institute for Welfare (IMSS-BIENESTAR), Colima 28085, Mexico.
Carmen A Sánchez-RamírezDepartment of Molecular Medicine, School of Medicine, University of Colima, Colima 28040, Mexico.ORCID 0000-0002-3525-7821
Fabian Rojas-LariosDepartment of Molecular Medicine, School of Medicine, University of Colima, Colima 28040, Mexico.ORCID 0000-0003-1744-9173
Alejandrina Rodriguez-HernandezDepartment of Molecular Medicine, School of Medicine, University of Colima, Colima 28040, Mexico.
Mario Ramírez-FloresDepartment of Molecular Medicine, School of Medicine, University of Colima, Colima 28040, Mexico.ORCID 0000-0003-3375-715X
José Guzmán-EsquivelClinical Epidemiology Research Unit, Mexican Institute of Social Security, Villa de Alvarez 28984, Mexico.ORCID 0000-0002-6727-0051
Karmina Sánchez-MezaDepartment of Molecular Medicine, School of Medicine, University of Colima, Colima 28040, Mexico.ORCID 0000-0002-8702-0252
Ana C Espíritu-MojarroDepartment of Pediatrics, Mexican Institute of Social Security (IMSS), General Hospital of Zone No. 1, Villa de Alvarez 28984, Mexico.
Osval A Montesinos-LópezFaculty of Telematics, University of Colima, Colima 28040, Mexico.ORCID 0000-0002-3973-6547
Iván Delgado-EncisoDepartment of Molecular Medicine, School of Medicine, University of Colima, Colima 28040, Mexico.ORCID 0000-0001-9848-862X

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Breast cancer remains a leading cause of global cancer burden, with marked differences in incidence across countries. While biological risk factors are well established, understanding the broader structural and sociocultural influences has been less comprehensive. In this study, we analyzed harmonized data from 183 countries (2017-2023), encompassing 33 variables and 7 subvariables related to demographics, nutrition, environment, health, and healthcare access, drawn from open-access international databases. Spearman correlation analysis identified strong positive associations between breast cancer incidence and discontinued breastfeeding, high LDL cholesterol, out-of-pocket healthcare expenditure, and educational attainment. Conversely, poor sanitation, lack of handwashing facilities, unsafe water, and certain nutritional deficiencies exhibited robust negative correlations, likely reflecting under detection and reporting limitations in lower-resource settings rather than true protective effects. These findings were further explored using multiple linear regression, which explained approximately 73% of the variance in global breast cancer incidence. The final model highlighted discontinued breastfeeding, prevalence of cocaine use, unsafe sanitation, high out-of-pocket healthcare expenditure, limited handwashing access, and high processed meat consumption as the most influential independent predictors. Receiver operating characteristic (ROC) analysis confirmed strong predictive value for discontinued breastfeeding and out-of-pocket expenditure, with sanitation and hygiene variables showing paradoxical inverse associations. Our results emphasize that breast cancer risk is shaped not only by individual behaviors and genetics, but also by larger-scale structural, socioeconomic, and environmental factors. These patterns suggest that targeted interventions addressing both lifestyle behaviors and systemic inequities-such as promoting breastfeeding, reducing financial barriers to healthcare, and strengthening public health infrastructure-could meaningfully reduce the global burden of breast cancer. In conclusion, this study underscores the importance of multisectoral, equity-focused prevention strategies. It also highlights the value of country-level ecological analyses in uncovering upstream determinants of cancer incidence and calls for further research to disentangle individual and contextual effects in cancer epidemiology.

Indexed as

Breast NeoplasmsBreast FeedingFemaleGlobal HealthHumansIncidenceRisk FactorsSocioeconomic Factorsbreast cancereducational levelenvironmental factorshealthcare expenditurelevel of unhealthinesssociocultural factorssociodemographic factors

Identifiers

PMID41149473
PMCPMC12564140

What OpenQuestion holds

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LicenceCC BY
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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.