Death Rates Dropping, But Racial Disparities Remain in Breast Cancer

Improved treatment and early detection mean fewer women in the United States are dying from breast cancer, according to a study released by the American Cancer Society (ACS) that examined trends in the disease.

Researchers discovered that death rates decreased by 39% from 1989 to 2015, saving about 322,600 lives.

The report, which is published every two years, studies breast cancer rates, deaths, survival, and screening by race and ethnicity — Asian/Pacific Islander, non-Hispanic black, Hispanic, non-Hispanic white, and American Indian/Alaska Native women.

“There have been tremendous advances in the early detection and treatment of breast cancer,” says Carol DeSantis, MPH, a cancer epidemiologist and director of breast and gynecological cancer surveillance at the ACS, in an interview with CURE. “However, in monitoring cancer trends, we see that not all women have benefited equally from these advances. In addition to identifying states where black and white women have similar outcomes, in some U.S. states, outcomes are much worse for black women.”

From 2006 to 2015, there was a decrease in deaths in all groups. But, the death rate among non-Hispanic Black women continued to be higher than non-Hispanic white women.

The decrease in mortality occurred in both younger and older women, but has slowed among women younger than 50 since 2007. The study’s authors attribute this decrease to better treatment, such as adjuvant and hormonal therapy, as well as targeted therapies. In addition, more women are being diagnosed earlier through screening such as mammography, according to the study.

Breast cancer death rates were not significantly different in non-Hispanic black and non-Hispanic white women in seven states, including Massachusetts which underwent health care reform in 2006 resulting in near-universal health insurance coverage, says DeSantis, lead author on the study.

“Although white women are more likely to be diagnosed with breast cancer in the U.S., black women have been more likely to die from the disease,” she says. “Death rates have been dropping in both groups of women, but the decrease has been faster in white women than black women. The fact that several U.S. states have been able to achieve similar breast cancer outcomes for black and white women is remarkable as it indicates that these disparities are not inevitable.”

In January 2016, more than 3.5 million women with a history of breast cancer were alive in the U.S.

This report found significant gains for each stage of disease among non-Hispanic black and non-Hispanic white women. For those with regional-stage disease, survival increased from 68 to 89% in non-Hispanic white women and from 55 to 81% in non-Hispanic black women. In distant-stage disease, gains were bigger in non-Hispanic white women (19 to 37%) than non-Hispanic black women (16 to 26%).

Despite the study reporting a decrease in death rates, breast cancer remains the second leading cause of cancer death among women after lung cancer.

According to the ACS, a woman living in the U.S. has a 1 in 8 lifetime risk of being diagnosed with breast cancer.

In 2017, more than 252,000 new cases of invasive breast cancer and more than 63,000 cases of in situ breast cancer are expected to be diagnosed. And, more than 40,000 women will likely lose their battle with the disease per ACS statistics.

“We have seen much progress in breast cancer over the past three and half decades, with breast cancer death rates dropping 39% overall,” DeSantis says. “However, some U.S. patients with breast cancer experience significant barriers that result in them being diagnosed later and not having access to timely and quality breast cancer treatment.”

Other studies have shown that the disparities among non-Hispanic white and non-Hispanic black women can result from differences in stage at diagnosis, tumor characteristics, obesity, adherence and access and response to treatments. The authors suggest increasing access to health care in all states to help eliminate breast cancer disparities.

“Analyzing trends allow researchers and physicians to see where progress is being made, and perhaps even more importantly, it allows us to see which groups of women may be left behind and experiencing poorer outcomes,” says DeSantis.