Breast cancer mortality plummets by 44%, but alarming racial gaps persist

By Hugo Francisco de SouzaReviewed by Susha Cheriyedath, M.Sc.Oct 9 2024

Although breast cancer deaths have dropped by 44% over the past three decades, the latest findings show that Black, Native American, and underserved women continue to face higher mortality rates—underscoring the urgent need for equitable access to lifesaving care.

Breast cancer statistics 2024. Image Credit: Juice Verve / Shutterstock

In their most recent biennial update on American breast cancer statistics published in the journal CA: A Cancer Journal for Clinicians, the American Cancer Society (ACS) reports a steady 44% decline in breast cancer mortality compared to 1989, corresponding to approximately 517,900 fewer breast cancer-associated deaths. However, the bulk of reduced mortality risk applies to White women, with mortality rates among underserved populations, particularly American Indian and Alaska Native (AIAN) women, remaining largely unchanged.

The report further observed an alarming increase in breast cancer incidence by 1% annually between 2012 and 2021. Younger women (<50 years) and Asian American/Pacific Islander (AAPI) ethnicities were at the highest risk, with annual increases of 1.4% and 2.7%, respectively.

The study highlights early screening and diagnosis as crucial factors in decreasing breast cancer mortality but underscores the need for more uniform and equitable screening and treatment across all ethnicities. The lack of access to high-quality healthcare in underserved communities is a significant contributor to the disparities in mortality rates.

The study urges the US Congress to pass the Screening for Communities to Receive Early and Equitable Needed Services (SCREENS) for Cancer Act. This act would increase nationwide screening and treatment and potentially reduce healthcare system costs, further decreasing cancer mortality in the future.

Background

Breast cancer is a significant cause of mortality in the United States (US) women, ranking second after skin cancer for overall cancer mortality and leading among Black and Hispanic women. Unfortunately, breast cancer incidence continues to rise, with current estimates suggesting it to be the most frequently diagnosed cancer in American women.

Decades of research and advances in screening and treatment methodologies have substantially reduced breast cancer mortality. Still, sustained increases in cancer incidence, particularly in hormone receptor-positive cancers, and the aftereffects of the COVID-19 pandemic may undermine this progress.

"The encouraging news is breast cancer mortality rates continue to decrease thanks to advances in early detection and treatment," said Angela Giaquinto, associate scientist, cancer surveillance research at the American Cancer Society and lead author of the study. "But future progress may be thwarted by increasing incidence, especially among younger women, and the consequences of the COVID-19 pandemic, such as delayed diagnosis due to disruptions in screening."

The American Cancer Society (ACS) is a nationwide non-profit organization dedicated to eliminating cancer. Established in 1913, it has since expanded to six geographical regions and more than 250 regional offices throughout the US.

Biennial cancer statistics and research published by the ACS remains the leading repository of cancer-associated data for experts (CA: A Cancer Journal for Clinicians) and lay citizens (cancer.org). These publications routinely advise the US public health system and Congress on optimal interventions to address cancer disparities and curb cancer nationally.

About the report

The current report, titled "Breast Cancer Statistics, 2024," was published on October 1, 2024, and provides comprehensive analyses of breast cancer incidence and mortality across various age- and race/ethnicity subcohorts in the US. Study statistics were collated from the National Cancer Institute's (NCI's) Surveillance, Epidemiology, and End Results (SEER) program and the North American Association of Central Cancer Registries (NAACCR). Screening (mammography) records were obtained from the 2021 National Health Interview Survey conducted by the National Center for Health Statistics (NCHS) and the 2022 Behavioral Risk Factor Surveillance System.

Study data included short-term incidence and mortality rates and trends reported between 1998 and 2021, stratified by race/ethnicity, age, state, molecular subtype, and cancer stage. Additionally, archived SEER registries (n = 9) were queried for long-term trends (1975-2021). These data help provide a clearer understanding of how breast cancer impacts different demographic groups over time. Statistical analyses included age-standardized evaluations of absolute incidence and death rates (per 100,000 individuals) computed using the NCI's SEER*Stat platform.

Important findings

The current report estimates that 310,720 (13%) women will be diagnosed with breast cancer, and 56,500 patients (2%) will succumb to the disease in 2024 alone. A strong positive correlation between age and breast cancer incidence was identified, with women above the age of 50 comprising 84% of diagnoses and 91% of deaths.

Notably, more than half of all breast cancer deaths are expected in women over 70 years (52%). Incidence rates (4.2%) were also found to be highest in women aged 70-79, further establishing this age group as the most vulnerable to breast cancer mortality.

The median age for breast cancer diagnoses and mortality was estimated at 62 and 69 years, respectively, but race was found to alter these estimates significantly. Hispanic, AAPI, Black, and AIAN women are diagnosed with and potentially die from breast cancer 4-7 years earlier than their White counterparts.

One of the most concerning findings is the persistent racial disparity in outcomes. Despite having a 10% lower incidence than White women, AIAN women presented with a 6% higher mortality rate. Similarly, Black women showed 5% lower incidence but 38% higher mortality than White women. These disparities are exacerbated by systemic barriers to access in healthcare and unequal distribution of advanced treatment options.

"Women today are a lot less likely to die from breast cancer, but alarming disparities still remain, especially for Asian American, Pacific Islander, Native American, and Black women," said Dr. William Dahut, chief scientific officer at the American Cancer Society. "These gaps need to be rectified through sustained systematic efforts to ensure access to high-quality screening and treatment for every woman."

The report underscores that much of the progress in reducing mortality has been driven by innovations in early detection (e.g., mammography) and hormone-based clinical treatments. However, these interventions have historically been more accessible to White women, contributing to the growing racial disparity in outcomes. Furthermore, conventional breast cancer clinical trials have predominantly included White participants, further skewing intervention outcomes.

Conclusions and future directions

The present report highlights an overall reduction in breast cancer mortality (44% since 1989), but race/ethnicity-specific analyses reveal that most of these gains are demonstrated in White populations, with incidence and mortality rates in underserved populations remaining unchanged or, at times, increasing.

Study findings emphasize the need for uniform screening and treatment across racial subgroups, best achieved by the US Congress passing the Screening for Communities to Receive Early and Equitable Needed Services (SCREENS) for Cancer Act, thereby increasing early cancer detection and reducing the financial burden of medical procedures.

The ACS has also launched the "VOICES of Black Women study" to comprehensively evaluate cancer risk and outcomes in Black women between 25 and 55 years.

"Progress against breast cancer could be accelerated by mitigating racial disparities through increased racial diversity in clinical trials, targeted community partnerships, and other initiatives that increase access to high-quality screening and treatment among underserved women," said the report.