Racial differences in breast cancer patients

One thousand seventy-eight patients diagnosed with primary breast cancer were examined for racial differences in histopathologic and clinical parameters. There were no observed differences in tumor histopathologic type or tumor endocrine status between races. There were no differences with respect to time to breast tumor recurrence observed between black and white patients. However, differences were observed in factors that contributed to tumor stage at diagnosis and to tumor grade. Survival differences observed in univariant analysis of blacks vs. whites were explainable by the presence of more severe skin involvement, tumor grade, and tumor size at diagnosis in the black patients.     

A comparison of survival of black and white female breast cancer cases in Upstate New York

A comparison of observed (absolute) survival rates was made for 890 black and 24,372 white female breast cancer cases diagnosed at age 24-84 years from 1976 to 1981 while residents in Upstate New York, using data on passive follow-up as reported to the population-based New York State Cancer Registry. Although survival rates were significantly lower in black vs. white cases at 1 and 3 years after diagnosis for all stages combined, racial differences in survival within each clinical stage were small. Noteworthy were the nearly identical survival rates for blacks and whites diagnosed at stage 1 (local disease). Thus, black-white differences in socioeconomic status, especially when stage at diagnosis is considered. Within clinical stage 3 (metastatic) cases, however, survival tended to be poorer in younger (less than 60 years) black vs. white patients. These data suggest the need for programs aimed at early detection of breast cancer among black women at younger ages.     

Survival differences in breast cancer among racial/ethnic groups: a population-based study

In women, breast cancer is the most frequent solid tumor and the second leading cause of cancer death. Differences in survival of breast cancer have been noted among racial/ethnic groups, but the reasons are unclear. This report presents the characteristics and the survival experience of four racial/ethnic groups and evaluates the effects of stage, age, histology, and treatment on survival time. The distributions of prognostic factors and treatment among racial/ethnic groups are compared using female breast cancer patients from two population-based registries in Southern California. The main end points are observed survival time and survival by cause of death. The Cox model is used to estimate the relative risk of death in three minority groups compared with non-Hispanic whites, while controlling for several covariates. Breast cancer cases included in this study were 10,937 non-Hispanic whites, 185 blacks, 875 Hispanics, and 412 Asians. The median follow-up period was 76 months (range: 48-132). The median age at diagnosis was 64 years among non-Hispanic whites, 55 years among Hispanics (p = 0.001), 52 years among blacks (p = 0.001), and 50 years among Asians (p = 0. 001). There was more localized disease among non-Hispanic whites (61. 4%) than among blacks (50.8%) and Hispanics (52.2%), but not compared to Asians (59.7%). After controlling for stage, age, histology, treatment, and registry, overall survival significantly differed between non-Hispanic whites and blacks [relative risk (RR) = 2.27, 95% confidence interval (95% CI) 1.82-2.84) and between non-Hispanic whites and Hispanics (RR = 1.18, 95% CI 1.04-1.34). The same results were found for breast cancer death in blacks (RR = 2.32, 95% CI 1.76-3.07) and Hispanics (RR = 1.28, 95% CI 1.10-1.50). We found no difference between Asians and non-Hispanic whites in overall and cancer-related survival. These results show that stage of disease, age at diagnosis, histologic features and treatment for breast cancer differed among racial/ethnic groups. Moreover, black women, in particular, and Hispanic women with breast cancer had a higher risk of death compared to non-Hispanic white women, even after controlling for prognostic factors. These findings underline the necessity of improved screening and access to appropriate treatment among minority women for breast cancer.     

Black versus white racial differences in clinical stage at diagnosis and treatment of prostatic cancer in Connecticut.

BACKGROUND. There are few published data on stage-specific prostate cancer incidence rates in United States black patients versus white patients, and there are no data comparing treatment received by black versus white patients with prostate cancer. METHODS. Using data from a population-based cancer registry, the proportion of prostate cancers diagnosed in Connecticut from 1985-1988 at each clinical stage was examined for blacks and whites, along with stage-specific incidence rates. First course of treatment was also examined by clinical stage. RESULTS. The proportion of cases diagnosed at the metastatic stage was higher for black patients (35.4%) than for white patients (22.1%), and age-specific incidence rates for metastatic cancer were 1.5-3.3 times higher for black patients. Among localized-stage cases, the distribution of histologic grade (or degree of differentiation) did not differ in blacks versus whites, suggesting no difference in tumor aggressiveness or potential response to treatment. For localized (or A and B)-stage cancers, significantly lower use of prostatectomy in blacks versus whites younger than 70 years of age was the only important black-white difference, which requires confirmation in other studies. Frequency of use of hormonal therapy including endocrine surgery (orchiectomy) did not differ between black and white patients with pelvic metastases or disseminated disease. Comparisons were also made with data on treatment (all races combined) reported from the American College of Surgeons' national survey of prostate cancer cases diagnosed in 1983. CONCLUSIONS. Earlier detection of prostate cancer in blacks is needed to reduce black-white differences in stage at diagnosis and thereby reduce overall differences in survival rates. There was little evidence for inequities in treatment of prostate cancer for black patients versus white patients in Connecticut.     

Within-stage racial differences in tumor size and number of positive lymph nodes in women with breast cancer

BACKGROUND: Black women have higher breast cancer mortality rates, are more likely to be diagnosed at an advanced stage of disease, and have worse stage-for-stage survival than white women. It was hypothesized that differences in the tumor size and number of positive lymph nodes within each disease stage contribute to the survival disparity. METHODS: In the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) database, black and white women diagnosed with a first primary tumor (TNM stage I-IIIA breast cancer) between 1988 and 2003 were identified. The demographic and clinical characteristics were compared by race. Logistic regression models of the association between race and tumor size and lymph node status were developed. Cox proportional hazards models of the association between mortality and race, tumor size, lymph node status, and other covariates were also examined. RESULTS: Among 256,174 SEER cases (21,861 black and 234,313 white women), more black than white women with lymph node-negative breast cancer had tumors measuring >or=2.0 cm. Adjusted for tumor size, more black than white women had >or=1 positive lymph nodes (odds ratio [OR], 1.24; 95% confidence interval [95% CI], 1.20-1.28). The age-adjusted and TNM stage-adjusted mortality rate ratio for blacks versus whites was 1.56 (95% CI, 1.51-1.61). Adjustment for within-stage differences in tumor size and lymph node involvement were found to have a negligible effect. With adjustment for additional covariates, the rate ratio was 1.39 (95% CI, 1.35-1.44). In addition, the rate ratio reflecting racial disparity increased as the stage of disease increased. CONCLUSIONS.: Adjusting for within-stage differences in tumor size and lymph node status did not appear to reduce the racial disparity. The finding that disparities increased with higher stage of disease suggests that interventions aimed at reducing these differences should target women with more advanced disease.     

Bladder cancer: race differences in extent of disease at diagnosis

BACKGROUND: Blacks are less likely than whites to develop bladder cancer; although once diagnosed, blacks experience poorer survival. This study sought to examine multiple biological and behavioral factors and their influence on extent of disease. METHODS: A population-based cohort of black bladder cancer patients and a random sample of frequency-matched white bladder cancer patients, stratified by age, gender, and race were identified through cancer registry systems in metropolitan Atlanta, New Orleans, and the San Francisco/Oakland area. Patients were ages 20-79 years at bladder cancer diagnosis from 1985-1987, and had no previous cancer history. Medical records were reviewed at initial diagnosis. Of the patients selected for study, a total of 77% of patients was interviewed. Grade, stage, and other variables (including age, socioeconomic status, symptom duration, and smoking history) were recorded. Extent of disease was modeled in 497 patients with urothelial carcinoma using logistic regression. RESULTS: Extent of disease at diagnosis was significantly greater in Blacks than in Whites. Older age group, higher tumor grade, larger tumors, and presence of carcinoma in situ were related to greater extent of disease in blacks and in whites. Large disparities between blacks and whites were found for socioeconomic status and source of care. Blacks had greater symptom duration and higher grade. Black women were more likely to have invasive disease than white women; this difference was not seen among men. Blacks in unskilled occupational categories, perhaps reflecting socioeconomic factors, were at much higher risk for muscle invasion than whites. CONCLUSIONS: While specific relationships between variables were noted, an overall pattern defining black and white differences in stage did not emerge. Future studies should examine the basis upon which occupation and life style factors operate by using biochemical and molecular methods to study the genetic factors involved.     

Socioeconomic factors and breast cancer in black and white Americans

The incidence of breast cancer in the US is known to be higher among white than black women and among women of higher socioeconomic status (SES), but once a woman, either black or white, has the disease, she is more likely to have a recurrence and to die of breast cancer if she is of lower socioeconomic status. Explanations for these observed differences are varied and inconsistent making it clear that these reported differentials are not sufficiently understood. In understanding breast cancer in a multicultural setting, delay in diagnosis, follow-up, and treatment are frequently the focus of attention. However these factors do not sufficiently explain the observed differences between blacks and whites. A review of recent literature reveals an increasing focus on the role of SES in breast cancer etiology and progression; however, the confounding of SES with race/ethnicity (black vs. white) contributes to the insufficient understanding of the effect of these two factors. This report will focus on the interplay between race/ethnicity and SES and their relative effects upon analyses of survival from breast cancer. Findings are based on prospective clinical trial data. SES factors have been associated with most of the known or suspected risk factors for breast cancer incidence and progression. In addition to race/ethnicity, SES is also associated with diet, lifestyle factors, physical characteristics, and tumor characteristics. Without controlling for other risk factors, the ratios of risk for blacks with respect to whites for disease-free survival and overall survival were 1.30 (95% CI: 1.04–1.61) and 1.42 (95% CI: 1.15–1.76), respectively. However, after controlling for patient risk factors, such as the number of positive lymph nodes, tumor diameter, estrogen receptor status and socioeconomic factors, these differences decrease and are not statistically significant. Socioeconomic status is associated both with race/ethnicity and estrogen receptor status. A loglinear analysis demonstrates that the apparent association of race/ethnicity with estrogen receptor status is mediated by socioeconomic status. An implication of this finding is that environmental and lifestyle components rather than genetic factors associated with race may explain the observed differentials between black and white breast cancer patients. Knowledge of environmental factors associated with SES have the potential for providing important clues about the prevention and control of breast cancer.     

Racial variation in breast cancer treatment among Department of Defense beneficiaries

BACKGROUND:

Although the overall age‐adjusted incidence rates for female breast cancer are higher among whites than blacks, mortality rates are higher among blacks. Many attribute this discrepancy to disparities in health care access and to blacks presenting with later stage disease. Within the Department of Defense (DoD) Military Health System, all beneficiaries have equal access to health care. The aim of this study was to determine whether female breast cancer treatment varied between white and black patients in the DoD system.

METHODS:

The study data were drawn from the DoD cancer registry and medical claims databases. Study subjects included 2308 white and 391 black women diagnosed with breast cancer between 1998 and 2000. Multivariate logistic regression analyses that controlled for demographic factors, tumor characteristics, and comorbidities were used to assess racial differences in the receipt of surgery, chemotherapy, and hormonal therapy.

RESULTS:

There was no significant difference in surgery type, particularly when mastectomy was compared with breast‐conserving surgery plus radiation (blacks vs whites: odds ratio [OR], 1.1; 95% confidence interval [CI], 0.8‐1.5). Among those with local stage tumors, blacks were as likely as whites to receive chemotherapy (OR, 1.2; 95% CI, 0.9‐1.7) and hormonal therapy (OR, 1.0; 95% CI, 0.6‐1.4). Among those with regional stage tumors, blacks were significantly less likely than whites to receive chemotherapy (OR, 0.4; 95% CI, 0.2‐0.7) and hormonal therapy (OR, 0.5; 95% CI, 0.3‐0.8).

CONCLUSIONS:

Even within an equal access health care system, stage‐related racial variations in breast cancer treatment are evident. Studies that identify driving factors behind these within‐stage racial disparities are warranted. Cancer 2012;. © 2011 American Cancer Society.     

Differences in breast cancer prognosis among African-American and Caucasian women

This review explores factors potentially contributing to the disparity in survival after breast cancer between African-American and Caucasian women in the United States. A number of factors have been implicated as the cause of poorer survival for black women, including clinical and pathologic features of the disease that are indicative of poor prognosis, economic resource inequities, and differences in treatment access and efficacy. The latter is explored in detail using data from the National Surgical Adjuvant Breast and Bowel Project (NSABP), a nationwide multicenter clinical trials group for breast and colorectal cancers. Key studies into the disparity in breast cancer survival are reviewed according to proposed principal determinants of poorer outcome for black women. Results among black and white women participating in several randomized NSABP clinical trials are also presented. Primary endpoints in those studies were clinical and pathologic disease characteristics at study entry, time to disease progression or new cancers, and total survival time after breast cancer diagnosis and treatment. In most studies reported in the literature, the primary explanatory factor alone, such as stage of disease at diagnosis, did not fully account for differences in outcome between groups; when additional factors were taken into account, however, prognoses became more similar. Results from the NSABP clinical trials similarly indicated that when stage of disease and treatment were comparable, outcomes for blacks did not differ markedly from those of whites. In summary, black women, diagnosed at comparable disease stage as white women and treated appropriately, tend to experience similar breast cancer prognoses and survival. However, important clinical and pathologic disease characteristics may continue to place certain women at increased risk of poorer outcome, and warrant continued study. The opportunity for increased clinical trial participation by black women is encouraged.     

Prognosis after rectal cancer in blacks and whites participating in adjuvant therapy randomized trials.

PURPOSE: National health statistics indicate that blacks have lower survival rates from colorectal cancer than do whites. This disparity has been attributed to differences in stage at diagnosis and other disease features, extent and quality of treatment, and socioeconomic factors. We evaluated outcomes for blacks and whites with rectal cancer who participated in randomized clinical trials of the National Surgical Adjuvant Breast and Bowel Project (NSABP). The randomized trial setting enhances uniformity in disease stage and treatment plan among all participants. PATIENTS AND METHODS: The study included black (N = 104) or white (N = 1,070) patients from two serially conducted NSABP randomized trials for operable rectal cancer. Recurrence-free survival and survival were compared using statistical modeling to account for differences in patient and disease characteristics between the groups. RESULTS: Blacks and whites had largely similar disease features at diagnosis. After adjustment for patient and tumor prognostic covariates, the black/white recurrence hazard ratio (HR) was 1.25 (95% confidence interval [CI], 0.94 to 1.66). The mortality HR was somewhat larger at 1.45 (95% CI = 1.09 to 1.93). Outcomes were improved for both groups in the more recent trial, which employed systemic adjuvant chemotherapy in all treatment arms. CONCLUSION: Recurrence-free survival was modestly less favorable for blacks, whereas overall survival was more disparate. Outcomes between groups were more comparable than those noted in national health statistics surveys and other studies. Adequate treatment access and the identification of new prognostic factors that can identify patients at high risk of recurrence are needed to ensure optimal outcomes for rectal cancer patients of all racial/ethnic backgrounds.     

Racial disparity in renal cell carcinoma patient survival according to demographic and clinical characteristics

BACKGROUND:

Patients with renal cell carcinoma (RCC) who are black tend to have poorer prognosis than similar patients who are white. This study examined whether the racial disparity in RCC patient survival varies by demographic and clinical characteristics.

METHODS:

Nearly 40,000 patients (4359 black and 34,991 white) diagnosed with invasive RCC from 1992 to 2007 were identified from 12 registries in the National Cancer Institute Surveillance, Epidemiology, and End Results program, covering approximately 14% of the US population. Relative survival rates through 2008 were computed using the actuarial method.

RESULTS:

Proportionally more blacks than whites were diagnosed with RCC under age 50 and with localized cancer. Overall, the 5‐year relative survival rates were 72.6% (95% confidence interval 72.0%‐73.2%) for white and 68.0% (66.2%‐69.8%) for black patients. Survival was higher among women than men and among younger than older patients. Survival decreased with advancing tumor stage and, within each stage, decreased with increasing tumor size. Patients with clear cell RCC, a more common form among whites, had poorer prognosis than patients with papillary or chromophobe subtypes, which are more common among blacks. Survival for patients who received no surgical treatment (10.5% of white patients and 14.5% of black patients) was substantially lower than for patients treated with nephrectomy, with similar survival among whites and blacks. In all other demographic and clinical subgroups of patients, whites consistently had a survival advantage over blacks.

CONCLUSIONS:

Patients with RCC who are white consistently have a survival advantage over those RCC patients who are black, regardless of age, sex, tumor stage or size, histological subtype, or surgical treatment. Cancer 2013. © 2012 American Cancer Society.     

Socioeconomic status and breast carcinoma survival in four racial/ethnic groups: a population-based study

BACKGROUND: Although overall survival for invasive breast carcinoma remains high, black women experience poorer survival than whites. Less is known about the survival of Hispanics and Asians, who may share clinical and socioeconomic risk factors similar to blacks. To better understand racial/ethnic survival patterns, we investigated the effect of socioeconomic status (SES) and disease stage on racial/ethnic differences in breast carcinoma survival in a large population-based cohort. METHODS: Using data from the Surveillance, Epidemiology, and End Results program (SEER), we identified 10,414 white, 940 black, 1100 Hispanic, and 1180 Asian females diagnosed with breast carcinoma in the Greater San Francisco Bay Area between 1988 and 1992. We used the Kaplan-Meier method to generate survival rates and Cox proportional hazards regression to estimate the risk of death by race/ethnicity, after adjustment for clinical, demographic, and census-derived SES variables. RESULTS: The 10-year unadjusted survival rates were 81% for whites, 69% for blacks, 75% for Hispanics, and 79% for Asians. Adjusting for stage decreased the relative risk of mortality for blacks from 1.81 to 1.29; the stage-adjusted relative risk for Hispanics (1.11) and Asians (1.02) did not differ significantly from whites. Additional adjustment for age, tumor characteristics, and treatment factors did little to alter the relative risk in blacks; adding blue-collar status to the model further decreased the relative risks for blacks to 1.22. Residing in a blue-collar neighborhood was independently associated with a 1.16 increase in risk of death. CONCLUSIONS: After adjustment for multiple factors, blacks continue to have slight but significantly poorer survival after breast carcinoma compared with whites, whereas the survival of Hispanics and Asians did not differ from whites.     

Conservative surgery and radiation therapy in black women with early stage breast cancer. Patterns of failure and analysis of outcome.

Between 1977 and 1986, 75 black and 615 white women with American Joint Committee (AJC) Stages I and II breast cancer were treated with excisional biopsy, axillary dissection, and radiation therapy for breast conservation. Cyclophosphamide, methotrexate, and 5-fluorouracil, with and without prednisone and tamoxifen, was given to 92% of premenopausal, 83% of perimenopausal, and 63% of postmenopausal node-positive women; 20 of 106 (19%) postmenopausal node-positive women received tamoxifen only. The clinical characteristics of the similarly treated patients were compared. The 5-year actuarial local only first failure rate was 5% for black women and 6% for white women (P = 0.53). Regional only failure as the first site of failure was 9% for blacks versus 1% for whites (P = 0.002), with regional recurrence as any component of first failure being 16% for blacks and 4% for whites (P = 0.001). The supraclavicular fossa was identified as the primary site of regional recurrence in black patients with either pathologically positive or negative axillae. Distant metastases as the only site of first failure were significantly greater in the black population with a 20% 5-year actuarial failure rate versus 11% in white patients (P = 0.01). The 5-year actuarial overall survival for the black patients was 82% versus 91% for the white patients (P = 0.01), with no-evidence-of-disease (NED) survival being 64% and 83% (P = 0.0002) and relapse-free survival (RFS) being 61% and 77% (P = 0.01), respectively. Black patients younger than 40 years of age or with pathologically positive axillary nodes had significantly worse NED, RFS, and overall survival compared with similarly staged white patients. Cosmetic results were analyzed at 3 and 5 years after completion of therapy. Although significantly fewer black patients had an excellent-to-good cosmetic result at 3 years compared with white patients, the results were not significantly different at 5 years. These results show that appropriately selected black patients with early stage breast cancer have excellent local control after conservative surgery and radiation therapy and should continue to be offered breast preservation as an alternative to mastectomy. Patterns of failure, however, demonstrated higher regional and distant recurrence rates and lower NED, RFS, and overall survival rates in most subsets of black patients reviewed.     

Breast cancer characteristics and outcomes among Hispanic Black and Hispanic White women

Evaluating breast cancer outcomes specific to Hispanics of different race (e.g. Hispanic Black, Hispanic White) may further explain variations in the burden of breast cancer among Hispanic women. Using data from the SEER 17 population-based registries, we evaluated the association between race/ethnicity and tumor stage, hormone receptor status, and breast cancer-specific mortality. The study cohort of 441,742 women, aged 20-79, who were diagnosed with primary invasive breast cancer between January 1, 1992 and December 31, 2008, included 44,246 Hispanic whites, 622 Hispanic Blacks, 44,797 non-Hispanic Blacks and 352,077 non-Hispanic whites. Hispanic black, Hispanic white and non-Hispanic black women had a 1.5-2.5 fold greater risk of presenting with stage IV breast cancer compared to non-Hispanic whites. All groups were significantly more likely than non-Hispanic whites to be diagnosed with ER+/PR- (1.1-1.5 fold increase) or ER-/PR- (1.4-2.2 fold increase) breast cancer. Hispanic black, Hispanic white and non-Hispanic black women had a 10-50?% greater risk of breast cancer-specific mortality compared to non-Hispanic whites. Our findings underscore the breast cancer disparities that continue to exist for Hispanic and black women, overall, as well as between Hispanic women of different race. These disparities highlight the factors that may lead to the poor outcomes observed among Hispanic and black women diagnosed with breast cancer, and for which targeted strategies aimed at reducing breast cancer disparities could be developed.     

Is the prevalence of ER-negative breast cancer in the US higher among Africa-born than US-born black women?

Previous studies have reported that the prevalence of ER-negative tumors in breast cancer patients is much higher in black women than in white women in the US. Herein, we examine whether the proportion (prevalence) in Africa-born black breast cancer patients residing in the US is similar to those in US-born black patients. We obtained information on invasive female breast cancers diagnosed during 1996-2008 in 17 Surveillance Epidemiology and End Results cancer registries according to select place of birth: Western-Africa-born, Eastern-Africa-born, Jamaica-born, and US-born blacks and US-born whites. The majority of Western-Africa-born and Eastern-Africa-born blacks were from Nigeria (64?%) and Ethiopia (74?%), respectively. We examined group variations in ER status using Chi-squared tests and the prevalence of ER-negative tumors in Africa-born blacks compared to US-born blacks, expressed as prevalence ratio (PRR), using multivariable regression models. The prevalence of ER-negative tumors significantly varied from 22.0?% (n?=?41/186) in Eastern-Africa-born to 32.9?% (n?=?47/143) in Western-Africa-born blacks. After adjustment for differences in age at diagnosis and other covariates, compared to US-born blacks, the prevalence was similar in Western-Africa-born (PRR?=?0.87; 95?% CI 0.70-1.08) and Jamaica-born blacks (PRR?=?0.88; 95?% CI 0.74-1.03), but significantly lower in Eastern-Africa-born blacks (PRR?=?0.58; 95?% CI 0.44-0.75). Notably, the ER-negative prevalence in Eastern-Africa-born black was comparable to the US-born whites with breast cancer. Our findings highlight the heterogeneity of breast cancer among black women in the US, which should be considered in future studies of hormone receptor status in these women.     

Race, nutritional status, and survival from breast cancer

The effects of nutritional status on differences in the survival of black and white women with breast cancer were studied in a cohort of 1,960 Georgia women diagnosed during 1975-1979. After data were adjusted for stage of disease, socioeconomic status, and other prognostic factors, poorer survival rates were shown in black women. Within each stage classification, lower levels of serum albumin and hemoglobin and higher relative body weight were more common among blacks and were independently associated with poorer survival. Among women with stage 3 disease, adjustment for these variables substantially reduced the excess mortality rate among blacks, suggesting that racial differences in survival may be partly explained by differences in nutritional status or extent of disease within stage.     

Breast cancer in black and white women in New York State. Case distribution and incidence rates by clinical stage at diagnosis

Case distributions and incidence rates by clinical stage at diagnosis were examined for 47,198 white and 4443 black female breast cancer cases diagnosed among residents of New York State from 1976-1981 and reported to the population-based New York State Cancer Registry. Proportions of cases diagnosed at "regional" and (especially) "metastatic" clinical stages were significantly higher in blacks versus whites, and incidence rates for "metastatic" cancers were slightly higher in blacks in some age groups (less than 60 years). The proportion of metastatic cancers differed significantly by race for single, married, and widowed cases, with younger (less than 60 years) black single women showing the highest proportions. The ranking of counties by black-white differences in per capita income was significantly associated with rankings by black-white differences in proportion of metastatic cancers. Possible explanations for this association, in terms of patient delay, and implications for cancer screening and medical care, were discussed.     

Breast cancer statistics, 2019

This article is the American Cancer Society’s biennial update on female breast cancer statistics in the United States, including data on incidence, mortality, survival, and screening. Over the most recent 5-year period (2012-2016), the breast cancer incidence rate increased slightly by 0.3% per year, largely because of rising rates of local stage and hormone receptor-positive disease. In contrast, the breast cancer death rate continues to decline, dropping 40% from 1989 to 2017 and translating to 375,900 breast cancer deaths averted. Notably, the pace of the decline has slowed from an annual decrease of 1.9% during 1998 through 2011 to 1.3% during 2011 through 2017, largely driven by the trend in white women. Consequently, the black–white disparity in breast cancer mortality has remained stable since 2011 after widening over the past 3 decades. Nevertheless, the death rate remains 40% higher in blacks (28.4 vs 20.3 deaths per 100,000) despite a lower incidence rate (126.7 vs 130.8); this disparity is magnified among black women aged <50 years, who have a death rate double that of whites. In the most recent 5-year period (2013-2017), the death rate declined in Hispanics (2.1% per year), blacks (1.5%), whites (1.0%), and Asians/Pacific Islanders (0.8%) but was stable in American Indians/Alaska Natives. However, by state, breast cancer mortality rates are no longer declining in Nebraska overall; in Colorado and Wisconsin in black women; and in Nebraska, Texas, and Virginia in white women. Breast cancer was the leading cause of cancer death in women (surpassing lung cancer) in four Southern and two Midwestern states among blacks and in Utah among whites during 2016-2017. Declines in breast cancer mortality could be accelerated by expanding access to high-quality prevention, early detection, and treatment services to all women.     

Variation in tumor natural history contributes to racial disparities in breast cancer stage at diagnosis

Black women tend to be diagnosed with breast cancer at a more advanced stage than whites and subsequently experience elevated breast cancer mortality. We sought to determine whether there are racial differences in tumor natural history that contribute to these disparities. We used the University of Wisconsin Breast Cancer Simulation Model, a validated member of the National Cancer Institute’s Cancer Intervention and Surveillance Modeling Network, to evaluate the contribution of racial differences in tumor natural history to observed disparities in breast cancer incidence. We fit eight natural history parameters in race-specific models by calibrating to the observed race- and stage-specific 1975–2000 U.S. incidence rates, while accounting for known racial variation in population structure, underlying risk of breast cancer, screening mammography utilization, and mortality from other causes. The best fit models indicated that a number of natural history parameters must vary between blacks and whites to reproduce the observed stage-specific incidence patterns. The mean of the tumor growth rate parameter was 63.6 % higher for blacks than whites (0.18, SE 0.04 vs. 0.11, SE 0.02). The fraction of tumors considered highly aggressive based on their tendency to metastasize at a small size was 2.2 times greater among blacks than whites (0.41, SE 0.009 vs. 0.019, SE 0.008). Based on our simulation model, breast tumors in blacks grow faster and are more likely to metastasize earlier than tumors in whites. These differences suggest that targeted prevention and detection strategies that go beyond equalizing access to mammography may be needed to eliminate breast cancer disparities.     

Differences in breast cancer hormone receptor status and histology by race and ethnicity among women 50 years of age and older.

Numerous studies have demonstrated differences in certain biological breast cancer characteristics associated with survival, including hormone receptor status and histology, among women of different racial and ethnic groups. However, women classified as "Asian or Pacific Islanders" or "Hispanic whites" represent heterogeneous populations, and few studies have separately evaluated subgroups of these populations with respect to these breast tumor characteristics. Using data obtained from 11 cancer registries that participate in the Surveillance, Epidemiology, and End Results (SEER) Program, the tumor characteristics of 93,317 women in whom invasive breast cancer was diagnosed from 1992 to 1998 were compared by race and ethnicity using unconditional and polytomous logistic regression. The study consisted of 75,978 non-Hispanic whites, 6,915 African Americans, 203 Native Americans, 5,750 Asians/Pacific Islanders, and 4,471 Hispanic whites. Eight Asian/Pacific Islander and four Hispanic white subgroups were also analyzed separately. Relative to non-Hispanic whites, African Americans, Native Americans, Filipinos, Chinese, Koreans, Vietnamese, Indians/Pakistanis, Mexicans, South/Central Americans, and Puerto Ricans living in the United States had 1.4- to 3.1-fold elevated risks of presenting with estrogen receptor-negative/progesterone receptor-negative breast cancer. Numerous differences by histological type, including lobular, ductal/lobular, mucinous, comedocarcinoma, tubular, and medullary histologies, were also observed by race/ethnicity. Breast cancer tumor characteristics differ by race/ethnicity in the United States. Both biological and lifestyle factors likely contribute to these findings. Our results may explain, to some extent, the differences in breast cancer stage and survival observed by race/ethnicity. Understanding the factors underlying these differences may provide further insight into breast cancer etiology in different populations.