Breast cancer death rate declines, but racial disparities have ‘remained unabated’
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Breast cancer death rates in the United States declined sharply over the past 30 years but racial disparities persist, according to a report from American Cancer Society.
The breast cancer death rate decreased by 43% from 1989 to 2020, findings published in CA: A Cancer Journal for Clinicians showed.
The decline — which report authors attributed to treatment advances, increased awareness and earlier detection through screening — equated to 460,000 fewer breast cancer deaths during that period.
However, distinct differences in outcomes by race persist.
Although breast cancer incidence is lower among Black women than white women (127.8 vs. 133.7 per 100,000), breast cancer mortality is 40% higher among Black women (27.6 vs. 19.7 per 100,000), the report showed. The elevated mortality risk for Black women vs. white women is even greater among those aged younger than 50 years (12.1 vs. 6.5 per 100,000).
Black women have the lowest survival of any ethnic or racial group for every molecular subtype, as well as for every disease stage except stage I, according to the report. The largest gaps have been observed for stage III (64% vs. 77%) and stage IV (20% vs. 31%).
In addition, Black women remained less likely than any other racial or ethnic group to be diagnosed with breast cancer at a localized stage (57% for Black women vs. 68% for white women).
The disparity “has remained unabated for a decade” despite increasing awareness within the oncology community, report authors wrote.
“Despite continued progress in reducing the risk of death from breast cancer, there is an alarming persistent gap for Black women,” Rebecca Siegel, MPH, senior scientific director for surveillance research at American Cancer Society, said in a press release. “This is not new, and it is not explained by more aggressive cancer.
“We have been reporting this same disparity year after year for a decade,” Siegel added. “It is time for health systems to take a hard look at how they are caring differently for Black women.”
Expanded access to high-quality prevention, early detection and treatment through Medicaid expansion and partnerships between health systems, advocacy organizations and community stakeholders could mitigate these disparities, the authors wrote.
“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,” researcher Ahmedin Jemal, DVM, PhD, senior vice president for surveillance and health equity science at American Cancer Society, said in the release. “Coordinated and concerted efforts by policymakers and health care systems and providers are needed to provide optimal breast cancer care to all populations — including expansion of Medicaid in the nonexpansion Southern and Midwest states, where Black women are disproportionately represented. Also, increased investment is needed for improved early detection methods and treatments.”
Breast cancer incidence increased by 0.5% per year since 2004, a trend the report’s authors attribute to diagnoses of hormone receptor-positive disease and localized disease.
Although the death rate declined over the 31-year period analyzed, the pace of the decline slowed from 1.9% per year between 2002 and 2011 to 1.3% per year from 2011 to 2020. Report authors attribute this in part to increased incidence.
Researchers reported declines in breast cancer death rates among every racial/ethnic group except Alaska Native and American Indian women, for whom rates remained stable.
Alaska Native and American Indian women appeared 4% more likely to die of breast cancer than white women despite being 17% less likely to be diagnosed.
References:
- Giaquinto AN, et al. 2022. CA Cancer J Clin. 2022;doi:10.3322/caac.21754.
- New ACS report: decrease in breast cancer mortality rate continues; wide gap for Black women remains stagnant (press release). Available at: pressroom.cancer.org/BCFF2022. Published Oct. 3, 2022. Accessed Oct. 3, 2022.
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Giaquinto AN, et al. 2022. CA Cancer J Clin. 2022;doi:10.3322/caac.21754.
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