Cancer society: Racial disparities in breast cancer survival persist

DeSantis C. CA Cancer J Clin. 2013;doi:10.3322/caac.21203.

  • October 23, 2013

Survival differences based on race and ethnicity still persist among patients with breast cancer, with black women continuing to demonstrate the poorest survival, according to statistics released by the American Cancer Society.

“Continued progress in the control of breast cancer will require sustained and increased efforts to provide high-quality screening, diagnosis and treatment to all segments of the population,” Carol DeSantis, MPH, an epidemiologist with the American Cancer Society, and colleagues wrote in a paper published in CA: A Cancer Journal for Clinicians.

The cancer society estimates 232,340 women in the United States will be diagnosed with new cases of invasive breast cancer in 2013, and 39,620 women are expected to die of the disease.

From 2006 to 2010, the most recent 5-year period for which data are available, the average incidence rate of breast cancer was highest among white women (127.3 cases per 100,000 women) and lowest among Asians/Pacific Islanders (84.7 cases per 100,000). Researchers noted the incidence rates among white women and black women (118.4 cases per 100,000) are converging, especially among women aged 50 to 59 years.

Incidence rates from 2006 to 2010 increased by 0.2% among black women and decreased by 0.6% per year among Hispanic women. Incidence did not change significantly among other races/ethnicities.

Breast cancer mortality rates have declined by 34% overall since 1990 due to early detection and improvements in treatment, DeSantis and colleagues wrote. Mortality rates declined among all races during that period except for American Indians/Alaska Natives.

Still, the statistics demonstrate considerable disparities in survival based on race.

From 2006 through 2010, the breast cancer death rate was highest among black women (30.8 deaths per 100,000) and lowest among Asians/Pacific Islanders (11.5 deaths per 100,000). The breast cancer death rate among white women was 22.7 deaths per 100,000).

“The higher death rate among African-Americans, despite their having a lower incidence rate than non-Hispanic whites, is due to both a later stage of disease at diagnosis and poorer stage-specific survival,” the authors wrote. “For example, the 5-year relative survival for regional-stage breast cancer is 74% in African American women compared with 86% in white women.”

Incidence rates for ER-negative breast cancers decreased among women of most races and age groups. Incidence rates of ER-positive breast cancers increased among white women aged 30 to 49 years, Hispanic women aged 60 to 69 years, and black women aged younger than 70 years.

“These divergent trends may reflect etiologic heterogeneity and the differing effects of some factors, such as obesity and parity, on risk by tumor subtype,” DeSantis and colleagues wrote.

Perspective

Jame Abraham

  • The striking disparity in survival rates among African-American women with breast cancer could be due to many different factors, such as difference in biology, late-stage diagnosis and lack of access to effective treatment. But in the current environment of health care debate, it is very important to remember the key modifiable factor — access to health care. That may be the single most important factor that can effectively control and improve mortality rate in African-American women. Access to primary care, appropriate and timely screening, prompt diagnosis and access to highly effective treatment could clearly improve survival rates and decrease mortality among African-American women. As a society, it is important for us to continue to work on improving disparities in survival rates among different patient populations.

    • Jame Abraham, MD
    • Director, Breast Oncology Program
      Cleveland Clinic Taussig Cancer Institute
  • Disclosures: Abraham reports no relevant financial disclosures.