Despite Decades of Progress, Breast Cancer Disparities Persist

Report finds that new cases are also increasing, especially in certain populations

Rachel Nania,

AARP

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Published October 01, 2024

an illustration of a pink ribbon for breast cancer awareness on a light pink background

AARP (Source: Shutterstock)

Breast cancer mortality rates have fallen significantly since the late 1980s, thanks in large part to advances in early detection and treatment. But a new study from the American Cancer Society shows that not all populations in the United States have experienced this progress evenly.

While breast cancer mortality rates have dropped by 44 percent overall in the last three decades — this translates to approximately 517,900 fewer deaths — they have improved only slightly for Asian American and Pacific Islander women and have remained unchanged for American Indian and Alaska Native women.

Disparities also persist for Black women, who are 5 percent less likely to develop breast cancer than white women but are 38 percent more likely to die from the disease, according to the report published Oct. 1 in the journal CA: A Cancer Journal for Clinicians. The researchers note that Black women have the lowest survival rate for every subtype and stage of breast cancer, except for localized disease.

“A 44 percent decrease in mortality since 1989 is really incredibly gratifying, but these gains have not been seen equally in all populations,” William Dahut, M.D., chief scientific officer at the American Cancer Society, said in a media briefing. In a news release he noted that “these gaps need to be rectified through systematic efforts to ensure access to high-quality screening and treatment for every woman.”

Researchers track an uptick in breast cancer incidence

Another point of concern highlighted in the report, which analyzed data from the National Cancer Institute and the Centers for Disease Control and Prevention (CDC), is in the increasing rate of new diagnoses, including in women under 50.

The vast majority of invasive breast cancer cases and deaths still occur in women 50 and older, and a little more than half of all breast cancer deaths (52 percent) are in women 70 and older, the report states. But researchers are tracking an increasing number of cases in younger women, “where there’s really no screening going on,” Dahut says. Routine breast cancer screenings aren’t recommended until women are at least 40.

New breast cancer cases are rising annually by about 1 percent overall in the U.S. and 1.4 percent in women under 50, the new study shows. Some populations are seeing an even sharper rise in new cases. In Asian American and Pacific Islander women, cases are increasing by 2.7 percent per year in women under 50 and 2.5 percent in those 50 and older, and in Hispanic women breast cancer incidence is rising by 2.4 percent in women under 50 and 1.6 percent in those 50-plus.

The overall uptick isn’t just evident on paper: “It’s also something that we’re seeing in the clinic,” says Taiwo Adesoye, M.D., an assistant professor in the Department of Breast Surgical Oncology at the University of Texas MD Anderson Cancer Center.

“The reality is that breast cancer still remains a major challenge for individuals across the country,” American Cancer Society CEO Karen E. Knudsen said in the meeting briefing.

This year alone, an estimated 310,720 women will be diagnosed with invasive breast cancer and an additional 56,500 cases of the noninvasive ductal carcinoma in situ will be diagnosed. Approximately 42,250 women will die from the disease in 2024.

“I also would like to not leave out men from the state of play, because although breast cancer for men is rare, it is real, and it also is something that is of grave concern given the mortality rate,” Knudsen said. Nearly 2,800 men will be diagnosed with breast cancer in 2024, and roughly 530 will die, according to the American Cancer Society.

Experts call for better access to screening and more research

The factors influencing these trends are likely “multifaceted,” Knudsen said.

An estimated 67 percent of women age 40 and older in the U.S. had a breast cancer screening in the past two years, the report found, and Black women have the highest screening rate (73 percent). Even still, Black women are less likely than white women to have high-quality screening, the report's lead author, Angela Giaquinto, said in an email to AARP, and they are more likely to experience delays in diagnosis and treatment following their mammography screening.

Breast cancer screening rates hover around 51 percent for American Indian/Alaska Native women and 62 percent for Asian American women. What’s more, Hispanic women are less likely to be screened than white women, the report found.

“Understanding what needs to be done differently as far as screening prevention is critical,” Dahut said. For example, Knudsen added, “having mammography nights and weekends or mornings and weekends is incredibly effective at getting an increased uptake for cancer screening.”

Also key, Dahut says, is follow-up after a screening. “An abnormal mammography needs to lead relatively quickly to a biopsy, and if cancer is found, a treatment plan,” Dahut said. “I think we’ve seen, sadly, a lag along the way from getting a mammography scheduled to actually having a biopsy done and then to beginning therapy, which is, I think, also a very important factor when we look at mortality outcomes.”

In draft guidelines, the U.S. Preventive Services Task Force recently lowered the recommended screening age from 50 to 40 to account for an increasing number of breast cancer cases in younger women. But “if one has concerns, one should certainly talk to the physician earlier on,” Dahut said, especially if there’s a family history of the disease.

Health insurance status is known to contribute to the disparities seen, the report’s authors note. And certain risk factors — like obesity, alcohol use, changing fertility patterns (delaying childbearing) and environmental exposures — could be influencing the trends uncovered in the report, though Dahut notes that more research is needed.

Recognize the warning signs of breast cancer

Staying on top of screenings is important, but so is paying attention to the warning signs of breast cancer — especially for women who are not yet eligible for routine mammograms and those in between mammograms. “Cancer can still develop in that time frame,” Adesoye says.

Her advice: “Know your normal. Make sure you understand what normal looks like for you.” Changes in the skin — whether it’s redness, scaling, dimpling or puckering — is a red flag, Adesoye says. So are nipple changes.

A new lump or mass is another reason to see a doctor, but know that breast cancer “is not a lump all the time,” Adesoye says. “It can be swelling of the breast; you can feel some swelling under the arm. These signs really should not be overlooked, because they can be early indicators of breast cancer.”

Another thing women can do is take steps to reduce their risk of developing breast cancer. While most women who are diagnosed with breast cancer have no known risk factors, approximately 30 percent of cases can be attributed to potentially modifiable risk factors, such as excess weight, alcohol use and physical inactivity, the American Cancer Society says.

According to the CDC, some research suggests that smoking, exposure to certain chemicals and changes in hormones due to medication or shift work may also influence breast cancer risk.

“And of course, it’s important to just keep getting your mammograms regularly,” Adesoye says. “Even though it doesn’t increase or decrease your risk, it is crucial for early detection, which, in the long term, improves outcomes.”

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