Adverse Social Determinants Linked to Fatalistic Cancer Beliefs

The study covered in this summary was published on as a preprint and has not yet been peer reviewed.

Key Takeaway

  • People experiencing adverse social determinants of health are more likely to have fatalistic beliefs about cancer that can lead to poor outcomes.

Why This Matters

  • Adverse socioeconomic circumstances are strongly correlated with poor cancer outcomes.

  • Fatalistic views about cancer ― for instance, that cancer is an automatic death sentence and that nothing can be done to prevent it ― are also strongly correlated with poor outcomes. People with such beliefs are less likely to be screened for cancer, to have problems checked out early, and to follow treatment and prevention advice.

  • In the current study, researchers connected these two well-known phenomena and showed that socioeconomic struggles and social stressors go hand in hand with fatalistic beliefs about cancer.

  • The findings reveal a previously unrecognized driver of healthcare disparities and suggest a new approach to address them: educating at-risk people may help influence their negative cancer beliefs.

Study Design

  • Investigators surveyed 859 people in the greater Philadelphia area about their cancer-related knowledge, risk behaviors, screening practices, and sociodemographic characteristics.

  • The researchers calculated a social determinants of health (SDoH) score for each participant. Scores ranged from 0 to 9 points. Participants were assigned 1 point each for being food insecure; being of a race other than White; not being heterosexual; having unstable housing; lacking insurance; lacking a college education; living alone; experiencing discrimination; or experiencing poverty.

  • Participants rated how much they agreed with six beliefs: (1) cancer is most often caused by a person’s behavior or lifestyle; (2) it seems like everything causes cancer; (3) there’s not much you can do to lower your chances of getting cancer; (4) there are so many different recommendations about preventing cancer, it’s hard to know which ones to follow; (5) when I think about cancer, I automatically think about death; and (6) I’d rather not know my chances of getting cancer.

  • Two thirds of the participants were women, 64% were White, and 61% were younger than 41 years. About a quarter were impoverished, 36% had food insecurity, and 17% had unstable housing. The mean SDoH score was 2.4 points.

Key Results

  • The researchers found a statistically significant association between mean SDoH score and five of the six fatalistic cancer beliefs. For instance, those who strongly agreed with the statement, “When I think about cancer, I automatically think about death,” had a mean SDoH score of 3.1, whereas those who strongly disagreed had a mean SDoH score of 2.3 (P < .001).

  • Participants with a score greater than 2 were more likely to agree that they would not like to know their cancer risk, that cancer is a death sentence, and that there isn’t much you can do to lower your cancer risk.

  • Participants experiencing poverty were more likely to strongly disagree with the statement, “Cancer is most often caused by a person’s behavior or lifestyle” (36.3% vs 20.5%) and to agree with the statements, “It seems like everything causes cancer” (22.3% vs 15.5%), “When I think about cancer, I automatically think about death” (31.8% vs 21.2%), and “I’d rather not know my chances of getting cancer” (17% vs 9.1%).

  • People experiencing food and housing insecurity were also significantly more likely to agree that it seems like everything causes cancer, that there’s not much you can do to lower your chances of getting cancer, and that cancer is a death sentence.

  • Black and Hispanic participants more frequently felt that everything causes cancer and that cancer automatically means death.


  • Survey items were self-reported.

  • The SDoH score weighted each item equally, but some social determinants likely have more impact than others.

  • The greater Philadelphia area may not be generalizable to other areas of the US.


  • The work was funded by the National Cancer Institute.

  • The investigators have disclosed no relevant financial relationships.

This is a summary of a preprint research study, “Effect of Social Stressors and Social Determinants of Health (SDOH) on Cancer Beliefs: Analysis of a Cancer Center Catchment Area,” led by Ayesha Ali of Thomas Jefferson University, Philadelphia, provided to you by Medscape. The study has not been peer reviewed. The full text can be found at

M. Alexander Otto is a physician assistant with a master’s degree in medical science and a journalism degree from Newhouse. He is an award-winning medical journalist who has worked for several major news outlets before joining Medscape and also an MIT Knight Science Journalism fellow. Email: [email protected]

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