Decrease in breast cancer mortality rate continues. Wide gap for Black women remains stagnant

While breast cancer death rates dropped by 43% from 1989 to 2020, Black women continue to be 40% more likely to die from the disease despite lower incidence. These findings are outlined in the latest edition of the American Cancer Society's Breast Cancer Statistics, 2022, published in CA: A Cancer Journal for Clinicians.

Breast cancer is the most commonly diagnosed cancer among U.S. women after skin cancer. It is the second leading cause of cancer death among women overall, after lung cancer, but the leading cause of cancer death among Black and Hispanic women. In 2022, approximately 287,850 women in the U.S. will be diagnosed with invasive breast cancer and 43,250 will die from the disease.

Black women have lower breast cancer incidence than White women (127.8 vs. 133.7 per 100,000), but 40% higher breast cancer mortality (27.6 vs. 19.7 per 100,000). Among women under 50, mortality is two-fold higher (12.1 vs. 6.5 per 100,000). This racial disparity has persisted unabated since 2011.

"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. This is not new, and it is not explained by more aggressive cancer," said Rebecca Siegel, senior scientific director, surveillance research at the American Cancer Society and senior author of the report. "We have been reporting this same disparity year after year for a decade. It is time for health systems to take a hard look at how they are caring differently for Black women."

Other key findings from the report include:

• Breast cancer incidence has risen slowly since 2004 (by 0.5% per year) driven by diagnoses of localized-stage and hormone-receptor-positive disease.
• In total, the death rate dropped by 43% during 1989–2020, translating to more than 460,000 fewer breast cancer deaths during that time. This progress is due to earlier detection through screening and increased awareness, as well as advances in treatment.
• However, the pace of decline in breast cancer death rates has slowed from 1.9% annually from 2002 to 2011 to 1.3% annually from 2011 to 2020, likely in part reflecting increased incidence.
• Breast cancer death rates are declining in every racial/ethnic group except American Indian and Alaska Native women, among whom rates are stable.
• Black women are least likely of any racial/ethnic group to be diagnosed with breast cancer at a localized stage, 57% versus 68% in White women.
• Black women have the lowest 5-year relative survival rate of any racial/ethnic group 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.
• American Indian and Alaska Native women are 17% less likely to be diagnosed with breast cancer than White women, but 4% more likely to die from the disease.

"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," said Dr. Ahmedin Jemal, senior vice president, surveillance & health equity science and contributing author of the study.

"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."

"Lawmakers can and must do more to address the unequal burden of breast cancer among Black women, including increasing funding for the National Breast and Cervical Cancer Early Detection Program (NBCCEDP), a program jointly funded by federal and state governments that helps improve access to lifesaving breast and cervical cancer screenings," said Lisa A. Lacasse, president of the American Cancer Society Cancer Action Network (ACS CAN), the advocacy affiliate of the American Cancer Society.

"Taking this step is critical to closing this persistent gap and moving us closer to ending cancer as we know it, for everyone."