Breast cancer surpasses lung as top cause of cancer death among Black women
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Breast cancer has surpassed lung cancer as the leading cause of cancer-associated death among Black women in the U.S., according to an American Cancer Society report.
Black women are at lower risk for a breast cancer diagnosis but 41% more likely to die of breast cancer than white women, the Cancer Statistics for African American/Black People 2022 report showed.
“We update these reports on cancer occurrence in Black people every 2 to 3 years because this population is not only one of the largest in the United States, but it also experiences extreme cancer inequalities due to long-standing systemic racism, including a higher prevalence of risk factors and barriers to high-quality cancer care,” Rebecca Siegel, MPH, senior scientific director of surveillance research at American Cancer Society, told Healio.
“Cancer disparities have always been a focus at American Cancer Society, but recently a light has been shone on health inequalities more broadly,” Siegel added. “This is partly due to the disproportionate impact of the pandemic on communities of color — not just in terms of higher rates of severe COVID-19 illness and death, but the secondary impact, as well, such as unemployment and loss of health insurance, which exacerbate barriers to health care.”
Disproportionate burden
Black individuals already have a disproportionate burden of cancer, including some of the highest mortality and shortest survival of any racial/ethnic group for most cancers, according to Siegel.
“Black men are [twice as likely] to die [of] prostate cancer as white men and Black women are 41% more likely to die [of] breast cancer despite lower incidence,” she said.
The higher mortality rates are partially a consequence of late-stage diagnoses.
Two-thirds (67%) of breast cancers among white women are detected at an early stage compared with 57% of those detected among Black women, according to the report.
Five-year OS after breast cancer diagnosis is 92% among white women vs. 82% among Black women. Moreover, Black women achieved shorter survival regardless of stage at breast cancer diagnosis, a trend authors attributed to reduced access to high-quality health care.
“It was surprising to see that breast cancer surpassed lung cancer as the leading cause of death among Black women,” Siegel said. “Lung cancer is the leading cause of death by far in most groups as a consequence of the tobacco epidemic. However, recent advances in lung cancer early detection, diagnosis and treatment — including staging — have accelerated declines in the lung cancer death rate and even resulted in a decline in the number of lung cancer deaths.
“Typically, the number of cancer deaths will continue to increase year-over-year despite a decline in the death rate because of the aging and growth of the population,” Siegel added. “In this instance, the steep decline is sufficient to overcome the demographic shift.”
The ACS report also highlighted the following:
- An estimated 224,080 new cancer cases and 73,680 cancer deaths will occur among Black individuals in 2022;
- Within the past 5 data years, Black women had an 8% lower overall cancer incidence compared with white women but a 12% higher mortality rate; and
- The overall cancer mortality gap between Black and white individuals is narrowing because of a steeper decrease in prostate, lung and other smoking-associated cancers among Black people.
Action steps
Oncologists play an extremely important role in overcoming cancer disparities and improving the quality of care for Black individuals, Siegel said.
“First and foremost, providers can educate themselves and increase awareness of conscious and unconscious racial bias,” Siegel said. “Studies consistently show that a major contributor to disparities is the lower likelihood of receipt of guideline-concordant treatment among Black people compared with white people and a higher likelihood for treatment delays. Eliminating racial bias will help improve patient trust and compliance, which will ultimately improve outcomes.
“Second, we must ensure that all patients — especially people of color — have access to the resources they need to make the cancer journey as smooth as possible, including patient navigators, financial aid assistance and emotional and psychological support,” she added.
Black people disproportionately experience cost and transportation barriers that often can be overcome with increased patient-provider communication. There also is a need for more diversity in clinical trials, Siegel added.
“The progress that has been made in reducing overall cancer disparities is mostly because of the delayed benefits of steep reductions in smoking in the Black community in the 1970s and 1980s and not the result of successful interventions aimed at reducing disparities,” Siegel said. “In fact, for many common cancers, there has been no improvement. For example, breast cancer death rates were lower among Black women compared with white women in the 1970s; however, interventions like mammography and improved treatment initiated a disparity between Black and white women that grew from the mid-1980s until around 2011 and has remained stable since, with rates 40% higher among Black women despite a lower cancer incidence among Black women.”
For more information:
Rebecca Siegel, MPH, can be reached at rebecca.siegel@cancer.org.
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