Mortality Gap between Black and White Breast Cancer Patients Persists

Study Overview

To start, LifeScienceIntelligence asked Giaquinto to provide a brief overview of the study and how it was conducted. “Every two to three years, the American Cancer Society releases an update on the statistics for breast cancer in the US,” began Giaquinto.

“We use multiple data sources, including incidence data collected by the National Cancer Institute's Surveillance, Epidemiology, and End Results program and the Centers for Disease Control and Prevention's (CDC’s) National Program of Cancer Registries, mortality data reported by the CDC’s National Center for Health Statistics, and risk factor data collected by the CDC’s Behavioral Risk Factor Surveillance system and National Health Interview Survey,” she continued.

The data collected from this study can help researchers better understand what direction to steer research. Additionally, seeing pitfalls and discrepancies can help inform educational and public health initiatives.

Results: Prevalence

The first aspect of the study focused on the prevalence and mortality rates associated with breast cancer. “Our results show that breast cancer incidence rates for women in the US have continued to rise by about 0.5% per year in the last decade of data, 2010–2019,” stated Giaquinto.

Even though this diagnosis rate has increased in the past decade, in recent years, the breast cancer diagnosis rate has reduced. According to a study conducted by Quest Diagnostics and published by the American Society of Clinical Oncology, the breast cancer diagnosis rate today is 11% lower than before the COVID-19 pandemic.

It is thought that travel restrictions and other precautionary measures may have contributed to missed screenings and, thus, lower diagnostic rates.

Diagnosis Stage

While the incidence rate of breast cancer is increasing, Giaquinto and other clinicians are not disheartened. Giaquinto explained, “although breast cancer incidence is increasing slowly, the good news is the majority of new cases are diagnosed at a local stage, meaning cancer has not spread outside of the breast and treatment is more likely to be successful and less invasive.”

Early diagnosis is essential for improved patient prognosis. According to the National Breast Cancer Foundation, breast cancer has a five-year relative survival rate of 99% when detected early or in a localized state.

Hormone Receptor Positive Disease

Giaquinto also notes that most newly diagnosed breast cancers are hormone-receptor-positive diseases.

“A majority of these new cancers are hormone-receptor (HR)-positive diseases. Factors that increase the risk of HR-positive diseases, such as excess body weight and having fewer children, have been rising in the US and are likely driving this increase,” noted Giaquinto.

The National Institute of Diabetes, Digestive, and Kidney Disease states that one-third of US adults are overweight. Understanding how weight and other factors contribute to the prevalence of kidney disease can help providers and public health officials target their educational and prevention efforts.

Results: Mortality Rate

In addition to discussing prevalence, Giaquinto also researched breast cancer mortality rates. “Breast cancer death rates have been declining since 1989, leading to a 43% drop from 1989–2020, translating to 460,000 fewer breast cancer deaths,” she shared.

While the trends in death rates have been improving in the past few decades, Giaquinto implied that the reduction rate was nearing a plateau. “The decline has slowed from about 2% per year to 1% per year in the past decade.” 

Racial Discrepancies

A significant portion of the article was focused on the racial discrepancies in breast cancer mortality. Giaquinto began by saying, “breast cancer death rates have been decreasing overall due to earlier detection through widespread uptake of screening, as well as increased awareness and advancements in treatments.”

Despite the decrease in death rate, there is still a treatment gap between White and Black patients. “Unfortunately, not all women have benefitted equally. Black women are more likely to receive low-quality breast cancer screenings, which increases the likelihood for a tumor to be missed,” revealed Giaquinto.

“Black women are also more likely to experience delays between screenings, between an abnormal screen and follow-up, and between breast cancer diagnosis and treatment,” she continued.

This discrepancy is partially explained by the link between socioeconomic status and race.

“In the US, Black women are more likely to be lower income and uninsured or underinsured compared to White women, which further affects their access to high-quality cancer care and treatment. Further, Black women are more likely to be diagnosed with hormone-receptor-negative breast cancer, which is usually more aggressive and has fewer effective treatment options,” noted Giaquinto.

Giaquinto also shared that compared to White individuals, Black patients with breast cancer have a 40% higher death rate despite having lower incidence rates.

Besides the gap in mortality rates between White and Black patients, Giaquinto shared that the death rates are declining for all ethnic groups except Native American populations.

“Many racial disparities in breast cancer mortality are driven by unequal access to high-quality cancer screening and treatment. Policy and regulation are vital to ensure equitable access to high-quality care, regardless of insurance status, socioeconomic income, or race,” concluded Giaquinto.

“For instance, Medicaid expansion has been found to increase the number of people insured in the most vulnerable populations and positively impact cancer outcomes. Women of racial and ethnic minorities are less likely to be enrolled in clinical trials for breast cancer treatment. They are more likely to delay or even stop treatment due to financial hardship, showing that many parts of our healthcare system need to be scrutinized and improved.”

The results of this study display apparent healthcare inequities. Providers and healthcare officials are encouraged to advocate for equitable access to screenings, treatment, and care to improve outcomes.