brain or sensory impairments
A large national cohort study from South Korea has found that women with disabilities experience significant disparities in breast cancer diagnosis, treatment, and survival compared with women without disabilities, despite the country’s universal health insurance system. The findings, published in JAMA Network Open on November 13, 2025, highlight urgent gaps in equitable cancer care.
Large Cohort Links Disability With Later-Stage Presentation
The study analysed data from 150,412 women aged ≥30 years diagnosed with breast cancer between 2012 and 2019. Of these, 7443 (4.9%) had medically verified disabilities, classified by type and severity using Korea’s National Disability Registration System.
Although the overall stage distribution was similar between groups, women with disabilities were more likely to be diagnosed at a distant stage (5.1% vs 4.7%) or with unknown stage disease (3.5% vs 2.5%).
These disparities were more pronounced among women with severe disabilities—6.3% presented with distant disease and 4.1% had unknown stage at diagnosis. Women with brain or sensory impairments had the highest rates of advanced-stage presentation.
Lower Likelihood of Receiving Standard Treatments
Across the cohort, women with disabilities were less likely to receive standard treatments within four months of diagnosis, even after adjusting for age, comorbidities, income, residence, and cancer stage.
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Surgery: aOR 0.91 (95% CI, 0.85–0.98)
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Chemotherapy: aOR 0.77 (95% CI, 0.73–0.81)
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Radiotherapy: aOR 0.85 (95% CI, 0.79–0.90)
Treatment disparities were most marked in those with severe disabilities, who had lower odds of receiving surgery (aOR 0.81), chemotherapy (aOR 0.66), and radiotherapy (aOR 0.65). Patients with severe brain impairments had some of the lowest treatment uptake across all modalities.
Higher Overall Mortality
Overall mortality was significantly higher among women with disabilities:
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aHR 1.59 (95% CI, 1.50–1.69) compared with those without disability
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aHR 2.15 (95% CI, 1.98–2.33) among those with severe disability
These differences persisted even after accounting for comorbidities and treatments received. Survival analyses showed consistently poorer outcomes across most disability categories.
Socioeconomic and Clinical Context
Women with disabilities in the cohort were more likely to:
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be aged ≥65 years
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have higher comorbidity burden (mean CCI 5.8 vs 4.4)
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belong to the lowest income deciles
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live outside urban centres
Despite South Korea’s low out-of-pocket costs for cancer care (capped at 5% since 2016), the authors note that structural, physical, and socioeconomic barriers continue to limit equitable access. Prior research has identified factors such as inaccessible facilities, clinician bias, communication barriers, and reduced participation in screening programs.
Implications for Practice
This is the first study in Korea to evaluate breast cancer survival by disability status using linked national datasets. The authors conclude that individuals with disabilities face persistent and clinically significant disadvantages across the cancer care continuum—from diagnosis to treatment to survival.
They emphasise the need for targeted interventions, including:
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improving accessibility of screening and diagnostic services
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strengthening clinician training around disability-inclusive care
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enhanced coordination between oncology and disability support services
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policies aimed at mitigating socioeconomic disadvantages
In this comprehensive nationwide analysis, disability was consistently associated with later-stage diagnosis, reduced access to standard treatments, and higher mortality in women with breast cancer. The authors state that addressing disability-related barriers is essential to achieving equitable outcomes within Korea’s universal health system.
Paper: Choi HL, et al. Disparities in the Diagnosis and Treatment of Breast Cancer Among People With Disabilities. JAMA Netw Open. 2025;8(11):e2543559. doi:10.1001/jamanetworkopen.2025.43559 Access online here.
