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

## TL;DR

This study finds that social, economic, and environmental factors like poor sanitation and high healthcare costs are linked to higher breast cancer rates globally.

## Contribution

The study identifies new structural and sociocultural predictors of breast cancer incidence using global data from 183 countries.

## Key findings

- Discontinued breastfeeding, cocaine use, and high processed meat consumption are strong predictors of breast cancer.
- Poor sanitation and lack of hygiene facilities show paradoxical inverse associations with breast cancer incidence.
- A multiple regression model explains 73% of the variance in global breast cancer rates using sociocultural and structural factors.

## Abstract

Breast cancer is one of the most common and deadly cancers worldwide, and its occurrence varies greatly between countries. While biological factors are well-known, this study aimed to explore how social, economic, and environmental conditions may also influence breast cancer rates. By analyzing global data from 183 countries, researchers found that factors like low breastfeeding rates, cocaine use, poor sanitation, high out-of-pocket health costs, and diets rich in processed meats were linked to higher breast cancer incidence. Surprisingly, the lack of basic hygiene facilities was also strongly associated, but in unexpected ways. These findings suggest that improving public health systems, encouraging healthier lifestyles, and addressing broader social conditions could help lower breast cancer rates worldwide. This research offers new perspectives that may guide future studies, shape health policies, and support more effective prevention strategies.

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.