Breast cancer death rates may be declining, but not for Black women

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Breast cancer death rates decreased by 43% between 1989 and 2020 -- but not for everyone, particularly Black women, according to a report released by the American Cancer Society (ACS) on October 3 and published in CA: A Cancer Journal for Clinicians.

The discrepancy is dramatic, senior author Rebecca Siegel of the ACS said in a statement released by the society.

"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," she said. "This is not new, and it is not explained by more aggressive cancer."

The statistics regarding breast cancer are sobering. After lung cancer, it is the second leading cause of cancer death among women overall, but the primary cause of cancer death among Black and Latinx women, the ACS noted. The organization estimates that roughly 287,850 American women will be diagnosed with invasive breast cancer this year, and 15% of these -- more than 43,000 -- will die from it.

Although Black women have lower incidence of breast cancer than their white counterparts (127.8 cases compared with 133.7 per 100,000), they have a 40% higher mortality rate from the disease, at 27.6 deaths compared to 19.7 per 100,000 -- a trend that has persisted since 2011.

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

The report also noted the following:

  • Between 1989 and 2020, the breast cancer mortality rate for all women dropped 43%, which translates to 460,000 fewer deaths. The ACS attributes this rate decrease to earlier screening and treatment improvements.
  • Although mortality rates have decreased, incidence of breast cancer has risen since 2004, at about 0.5% per year -- which the ACS attributes to diagnoses of localized-stage and hormone-receptor-positive disease.
  • The pace of the decline of breast cancer death rates has slowed, from a drop of 1.9% each year between 2002 and 2011 to a decline of 1.3% each year between 2011 and 2020.
  • Death from breast cancer is declining in every racial/ethnic group except for Indigenous American women and Alaskan Native women, who have stable mortality rates. However, these two groups are 17% less likely to be diagnosed with breast cancer compared to white women and are 4% more likely to die of it.
  • Black women are least likely to receive a breast cancer diagnosis when the disease is still localized compared with their white peers, at 57% versus 68%.
  • Black women have the lowest five-year survival rate of any racial/ethnic group compared to white women for every breast cancer subtype except stage I; the biggest discrepancies are for stage III (64% vs. 77%) and stage IV (20% vs. 31%).

What do the findings suggest? The slowing decrease in breast cancer mortality points to "stagnant screening uptake and suboptimal receipt of timely and high-quality treatment," contributing author Dr. Ahmedin Jemal said in the ACS release.

"Coordinated and concerted efforts by policymakers 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," he said. "Also, increased investment is needed for improved early detection methods and treatments."

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