Report: Breast Cancer Death Rates Decline, but More Slowly Among Poor

A new report from the American Cancer Society finds that deaths from breast cancer in the United States continue to decline steadily. However, the decline has been faster for women who live in more affluent areas. Women from poor areas now have the highest rates of death from breast cancer.

“In general, progress in reducing breast cancer death rates is being seen across races/ethnicities, socioeconomic status, and across the U.S.,” said Otis W. Brawley, M.D., chief medical officer of the American Cancer Society. “However, not all women have benefitted equally. Poor women are now at greater risk for breast cancer death because of less access to screening and better treatments. This continued disparity is impeding real progress against breast cancer, and will require renewed efforts to ensure that all women have access to high-quality prevention, detection, and treatment services.”
The findings are published in Breast Cancer Facts & Figures 2011-2012 and in Breast Cancer Statistics, 2011 in CA: A Cancer Journal for Clinicians. The report, published every two years since 1996, provides detailed analyses of breast cancer trends and presents information on known risk factors for the disease, factors that influence survival, the latest data on prevention, early detection, treatment, and ongoing research.

Steady Decline

Breast cancer death rates have declined steadily since 1990. The drop has been larger among women under 50 (3.2% per year) than among women over 50 (2.0% per year).
An estimated 230,480 women will be diagnosed with invasive breast cancer in 2011. Breast cancer is the most common cancer among women in the United States, after skin cancer. Breast cancer accounts for nearly 1 in 3 cancers diagnosed in women. Men can get breast cancer too, but it is much rarer and accounts for only 1% of breast cancer cases in the United States. An estimated 39,520 women are expected to die from the disease in 2011.
In January 2008, the latest year for which statistics are available, approximately 2.6 million women living in the U.S. had a history of breast cancer. More than half of them were diagnosed less than 10 years earlier. Most of them were cancer-free, while others still had evidence of cancer and may have been undergoing treatment.

Race and Socioeconomic Factors

White women get breast cancer at a higher rate than African-American women, but African-American women are more likely to get breast cancer before they are 40, and are more likely to die from it at any age. This is likely because the cancer is more advanced when it is found in African American women, and because survival at every cancer stage is worse among African American women. Incidence and death rates for breast cancer are lower among women of other racial and ethnic groups.
Poverty and a lack of health insurance are also associated with lower breast cancer survival. In 2008, 51.4% of poor women ages 40 and older had a screening mammogram in the past 2 years compared to 72.8% of women who were not poor. The presence of additional illnesses, unequal access to medical care, and disparities in treatment also likely contributed to differences in breast cancer survival.
Death rates were highest among women who lived in affluent areas until the early 1990s, but since that time rates have been higher among women in poorer areas because the decline in their death rates began later and was slower.

Differences Among States

Trends in breast cancer death rates also vary by state. During 1998-2007, death rates declined in 36 states and the District of Columbia, but remained relatively unchanged in the remaining 14 states (Alabama, Alaska, Arkansas, Hawaii, Louisiana, Mississippi, Missouri, Montana, New Mexico, Oklahoma, South Dakota, Utah, Vermont, and Wyoming). The lack of a decline in these states is likely related to differences in the availability and quality of mammogram screening, as well as state differences in racial and socioeconomic composition.

Risk Factors

Breast cancer incidence and death rates generally increase with age. Ninety-five percent of new cases and 97% of breast cancer deaths occurred in women 40 years old and older.
Obese breast cancer patients have about a 30% higher risk of death compared to those who maintain a healthy weight. Research also suggests that exercise during and after treatment improves outcomes.
Women with a family history of breast cancer, especially in a mother, sister, daughter, father or brother, are at increased risk of developing breast cancer.
To find breast cancer early, when treatments are more likely to be successful, the American Cancer Society recommends women 40 and older have a mammogram and clinical breast exam every year, and younger women have clinical breast exams periodically as well.

By Stacy Simon

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