Structural Racism and Head and Neck Cancer Risks and Outcomes: A Scoping Review.

OBJECTIVE: Persistent health inequities exist in Head and Neck Cancer (HNC) outcomes among racial and ethnic minority populations. Structural racism creates inequitable population-level risk for health conditions, including cancer. This study is the first to review the effects of structural racism on HNC risk factors and outcomes. DATA SOURCES: PubMed, Embase, Scopus, ProQuest, PapersFirst, MedNar, and Open Access Theses and Dissertations. REVIEW METHODS: PRISMA guidelines were utilized to search 7 databases from inception to May 6, 2024. 6734 deduplicated titles and abstracts were screened, of which 45 underwent full-text review. Thirty-one studies met the inclusion criteria of reporting a domain of structural racism impacting head and neck cancer risk factors or outcomes. RESULTS: Survival outcomes of HNC in racial and ethnic minority populations were associated with and compounded by neighborhood factors and socioeconomic status. Insurance status affected survival disproportionately in Black compared to White participants. Black participants demonstrated stronger estimates of association for higher intensity and duration of cigarette smoking. Perceived barriers to access to care among Black males contributed to delays in seeking treatment. Native Hawaiian and other Pacific Islanders were more likely to present with advanced-stage disease and had worse disease-specific survival compared to White populations. CONCLUSION: Structural racism significantly contributes to disparities in HNC risk factors and treatment outcomes experienced by racial and ethnic minorities in the United States. Further research is needed to evaluate structural racism domains to inform multi-level interventions to eliminate inequities in HNC among racial and ethnic minority populations.