Breast cancer death rates decreased among all racial and ethnic groups from 1990 to 2015 in Florida, according to a study. But from 2010 to 2015, Black women were still twice as likely to die from breast cancer as white women.
The research was published in the July 2021 issue of the journal Cancer Epidemiology, Biomarkers & Prevention. Read the abstract of “Trends In Breast Cancer Survival by Race-Ethnicity in Florida, 1990-2015.”
Historical differences in breast cancer diagnoses and mortality
It has long been known that breast cancer diagnoses and mortality rates were different among women of different races and ethnicities.
In 1980, for example, white women were much more likely to be diagnosed with breast cancer than Black women.
Throughout the 1980s, breast cancer diagnoses increased in both Black women and white women, likely due to an increase in screening mammograms.
Rates of breast cancer in white women decreased from 1999 to 2004, possibly because fewer women used hormone replacement therapy (HRT), after a study linked HRT with an increase in breast cancer risk.
Rates of breast cancer in Black women increased dramatically in the late 1970s and 1980s. Since that time, rates have consistently inched up, and recent research has found that rates of breast cancer in Black women and white women are now fairly equal.
Black women and white women had similar breast cancer mortality rates from 1975 to 1981. Breast cancer mortality rates increased for both groups of women from the mid-1970s to the early 1990s. Still, this increase was nearly 5 times higher for Black women.
Since 1990, breast cancer mortality has been decreasing for white women. But for Black women, breast cancer mortality didn’t start to decrease until 1993, and the decrease was smaller than it was for white women.
Various organizations and groups have started a number of programs and initiatives to address these disparities in breast cancer outcomes.
The researchers did this study — which looked at breast cancer survival by race and ethnicity in Florida — to see how effective the programs are at eliminating disparities. The researchers also wanted to see if other targeted approaches to reduce disparities in breast cancer outcomes may be needed.
“Since the ’80s, there’s been increasing awareness of the disparities in breast cancer mortality and the troubling fact that they’ve grown over time,” lead author Robert Hines, Ph.D., MPH, associate professor of population health sciences at the University of Central Florida College of Medicine, said in a statement. “There’s been a huge investment in decreasing or eliminating these disparities, but we wanted to see if it’s been effective.”
The researchers focused on Florida because it is the third most populated state in the United States and is also fairly diverse: 27% of the population is Hispanic and 17% is Black.
About the study
The researchers looked at information from 257,171 Black women and white women ages 18 and older who were diagnosed with invasive breast cancer in Florida from 1990 to 2015. The information came from the Florida Cancer Data System, the statewide cancer registry.
The study excluded certain groups:
- women diagnosed with ductal carcinoma in situ (DCIS)
- women who’d had a previous cancer diagnosis
- women diagnosed with cancer whose disease stage was unknown
- women whose survival time was unknown
- women who were not Black or white
Of the 257,171 women in the study:
- 79.5% were non-Hispanic white
- 10.5% were Hispanic white
- 9.7% were non-Hispanic Black
- 0.3% were Hispanic Black
- about 33% were diagnosed between the ages of 50 and 64
Compared with non-Hispanic white women and Hispanic white women, non-Hispanic Black women and Hispanic Black women were:
- more likely to be diagnosed at a younger age, between the ages of 18 and 50
- more likely to live in high poverty neighborhoods
- more likely to be diagnosed with metastatic disease at first diagnosis
- more likely to be treated with chemotherapy
- less likely to be treated with surgery, radiation therapy, and hormonal therapy
The researchers estimated 5-year and 10-year breast cancer mortality rates for each racial and ethnic group of women based on the year they were diagnosed:
For all the racial and ethnic groups, breast cancer mortality gradually decreased from 1990 to 2015:
- Among non-Hispanic white women, 10-year mortality rates decreased from 20.6% in 1990-1994 to 14% in 2010-2015.
- Among non-Hispanic Black women, 10-year mortality decreased from 36% in 1990-1994 to 25.9% in 2010-2015.
So while breast cancer mortality did go down for Black women, the mortality rate was still nearly twice as high as breast cancer mortality for white women.
The researchers noted that several factors likely contributed to the higher breast cancer mortality rates for Black women:
- Black women were more like to be younger when diagnosed than white women.
- Black women were 4.5 times more likely to live in high poverty areas and more than 3 times more likely to be uninsured than white women.
- Black women were more likely to be diagnosed with metastatic disease and more likely to be diagnosed with higher grade cancer than white women.
- Black women were more likely to be diagnosed with hormone-receptor-negative and HER2-negative breast cancer than white women.
- Black women were less likely to be treated with surgery, radiation therapy, and hormonal therapy, and more likely to be treated with chemotherapy than white women.
- Black women were more likely to have delays in treatment than white women.
“Over the past three decades, we’ve seen an improvement in breast cancer survival for all women — especially for minority women — which is encouraging,” Dr. Hines said. “However, in the most recent time period, non-Hispanic Black women have twice the rate of breast cancer death compared to non-Hispanic white women. We need to celebrate the progress we make, but we have a ways to go to produce equitable outcomes for women diagnosed with breast cancer.”
Dr. Hines and his team want to identify specific reasons why we continue to see disparities in breast cancer outcomes, with the goal of creating better programs to close the gap.
“In order to have the most impact, we need to tease out the individual factors that are most responsible,” he said.
What this means for you
If you’re a Black woman who’s been diagnosed with breast cancer, there is a small amount of good news: Breast cancer survival has improved for all women during the past 30 years.
But from 2010 to 2015, breast cancer mortality rates were still much higher for Black women than they were for white women.
All women — no matter their race, ethnicity, age, economic status, or other health conditions — deserve the best breast cancer care and the best prognosis possible. Any differences that affect prognosis must be eliminated.
Regular doctor visits and breast cancer screenings are a good place to start. Breast cancer that is diagnosed early is typically easier to treat and offers the best survival chances. Regular screenings for breast cancer, including annual mammograms and breast exams by a medical professional, are important for everyone.
Paying for healthcare can be difficult, especially if you have limited income or are covered only by Medicaid. But if you’re older than 40, it is crucial that you get regular mammograms. Stick with the screening plan you and your doctor decide is best for you. If scheduling problems or cost concerns are stopping you from getting a mammogram, talk to your doctor, a hospital social worker, or a staff member at a mammogram center. Ask about free mammogram programs and healthcare services in your area. It’s your health and your future, and you deserve the best care possible.
Written by: Jamie DePolo, senior editor
Reviewed by: Brian Wojciechowski, M.D., medical adviser
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