Vital Signs: Racial Disparities in Breast Cancer Severity — United States, 2005–2009

Early Release
November 14, 2012 / 61(Early Release);1-6

Abstract

Background: Breast cancer death rates have been declining among U.S. women since 1990 because of early detection and advances in treatment; however, all racial groups have not benefited equally.
Methods: Breast cancer incidence, stage at diagnosis, and mortality rates for 2005–2009 for women in the United States and for each state were calculated using United States Cancer Statistics (USCS) data. Black to white mortality ratios and mortality to incidence ratios by race were calculated.
Results: Despite having lower incidence rates, black women had a 41% higher breast cancer death rate. More black women were diagnosed at regional or distant cancer stage compared with white women (45% versus 35%). For every 100 breast cancers diagnosed, black women had nine more deaths than white women (27 deaths per 100 breast cancers diagnosed among black women compared with 18 per 100 among white women).
Conclusions: Despite significant progress in breast cancer detection and treatment, black women experience higher death rates even though they have a lower incidence of breast cancer compared to white women.
Implications for Public Health Practice: Advances in screening and treatment have improved survival for U.S. women with breast cancer. However, black women experience inequities in breast cancer screening, follow-up, and treatment after diagnosis, leading to greater mortality. At the individual level, the maximal effectiveness of screening for breast cancer can only be achieved when all women have timely follow-up to breast cancer exams and state-of-the-art treatment. At the health system level, optimal health-care delivery may be strengthened through performance-based reimbursement, expanded use of information technology, and quality assurance reporting-protocols. Proven effective interventions such as patient navigation could be expanded for use in other settings.

Introduction

Breast cancer remains a significant public health challenge. It is the most commonly diagnosed cancer among US women. Although breast cancer deaths have declined over the last 2 decades, it remains the second leading cause of cancer deaths among women (1). It is estimated that approximately half of this decrease has resulted from advances in treatment and early detection (2). However, not all racial groups have benefited equally.
The continuum of breast cancer care begins with regular screening, and continues with timely follow-up and appropriate treatment (3). The maximum benefit of breast cancer screening will only be achieved if women of all racial groups receive not only optimal screening, but also timely follow-up and state-of-the-art treatment. Modeling studies have shown possible differences in mortality at each phase of this process (4).
This report summarizes disparities in breast cancer incidence and mortality between white and black women in the United States, using data from USCS for 2005–2009. USCS includes mortality data from the National Vital Statistics System (NVSS) and incidence data from the National Program of Cancer Registries (NPCR) and the Surveillance, Epidemiology, and End Results (SEER) program.