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Breast cancer mortality has declined during the past 30 years in the United States, but a racial gap continues to persist, according to newly released statistics from the American Cancer Society (ACS).  

Death rates from breast cancer dropped by 43% from 1989 to 2020, translating to 460,000 fewer breast cancer deaths during that time. The decline was similar for women of all racial/ethnic groups except American Indians/Alaska Natives, provera d for whom the rates remained stable.

However, despite this overall decline, Black women continue to be 40% more likely to die from the disease than White women, despite having a lower incidence of the disease.

The new report was published online October 3 in CA: A Cancer Journal for Clinicians.

“We found that despite continued progress in reducing the risk of death from breast cancer, there is an alarming persistent gap for Black women, who have a 40% higher risk of dying from breast cancer than White women despite lower incidence,” said senior author Rebecca Siegel, MPH, senior scientific director, surveillance research at the ACS.

“We have been reporting this same disparity year after year for a decade,” she added. “It is time for health systems to take a hard look at how they are caring differently for Black women.”

Siegel also noted that this disparity is not explained by Black women having a more aggressive cancer.

Breast cancer is the most commonly diagnosed cancer among women in the United States after skin cancer, and remains the second leading cause of cancer death among women overall. However, note the authors, it is the leading cause of cancer death among Black and Hispanic women. In 2022, approximately 287,850 women in the US are expected to be diagnosed with invasive breast cancer and 43,250 will die from the disease.

Disparities in Incidence and Mortality

In its latest compilation of breast cancer statistics, the ACS reported that incidence rates are highest in White women (133.7 per 100,000), followed closely by Black women (127.8 per 100,000), and are lowest in Hispanic and Asian/Pacific Islander (API) women.

The authors point out that these rates are for broad racial and ethnic groups and tend to mask possible heterogeneity within subpopulations. For example, breast cancer incidence rates of Native Hawaiian women are similar to those of White women.

Of the broadly defined racial and ethnic groups that were used in this analysis, Black women had the highest breast cancer death rate (27.6 per 100,000), as compared with White women (19.7 per 100,000), and more than double that in API women (11.7 per 100,000).

Racial and ethnic differences in breast cancer rates did vary somewhat by age, especially for incidence. For instance, Black women showed the highest incidence rate before age 40 years, while API women had the second highest rate (after White women) in those aged 45-49 years. Disparities between Black and White women in incidence and mortality are largest in young women and decline with age; for example, the breast cancer death rate for Black women is 1.8–2.4 times higher than that for White women among those aged 20-49 years vs 1.1–1.2 times higher in the group aged 70 years and older.

Black women were also the least likely of any racial/ethnic group to be diagnosed with breast cancer at a localized stage, 57% vs 68% in White women, and had the lowest 5-year relative survival rate for every breast cancer subtype and stage (except stage I), with the largest gaps for stage III (64% vs. 77%) and stage IV (20% vs 31%) disease.

Rising Incidence, Declining Mortality

The incidence of breast cancer in the US jumped during the 1980s and 1990s largely due to the rapid uptake of mammography screening, which increased in prevalence from 29% in 1987 to 70% in 2000.

Then from 2001-2004, the incidence of invasive breast cancer dropped sharply, primarily a result of the decreased use of hormone replacement therapy (HRT) following the publication of results from the Women’s Health Initiative trial, which linked HRT use to breast cancer and heart disease.

But since 2004, invasive breast cancer incidence has been rising slowly, by 0.5% per year, and this trend reflects in part an increased prevalence of excess body weight and declines in the fertility rate, the authors commented.

Breast cancer mortality is continuing to decline, although at a slower pace than during the 1990s and 2000s. Death rates dropped about 1.9% annually from 2002 to 2011 and then to 1.3% annually from 2011 to 2020.

“The slow decline in breast cancer mortality during the most recent period partly reflects stagnant screening uptake and suboptimal receipt of timely and high-quality treatment,” commented study author Ahmedin Jemal, DVM, PhD, senior vice president, surveillance & health equity science at ACS.

“Coordinated and concerted efforts by policy makers and healthcare systems and providers are needed to provide optimal breast cancer care to all populations, including expansion of Medicaid in the non-expansion Southern and Midwest states, where Black women are disproportionately represented. Also, increased investment is needed for improved early detection methods and treatments,” he said in a statement.

All the authors except for  Lisa A. Newman had no disclosures. Newman reported grants, personal fees and travel and other support, all outside the submitted work.

CA: A Cancer Journal for Clinicians. Published online October 3, 2022. Full text

Roxanne Nelson is a registered nurse and an award-winning medical writer who has written for many major news outlets and is a regular contributor to Medscape.

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