Trends in Breast Cancer by Race and Ethnicity

In this article, the American Cancer Society (ACS) describes trends in incidence, mortality, and survival rates of female breast cancer in the United States by race and ethnicity. It also provides estimates of new cases and deaths and shows trends in screening mammography. The incidence and survival data derive from the National Cancer Institute's Surveillance, Epidemiology, and End Results program; mortality data are from the National Center for Health Statistics. Approximately 211,300 new cases of invasive breast cancer, 55,700 in situ cases, and 39,800 deaths are expected to occur among women in the United States in 2003. Breast cancer incidence rates have increased among women of all races combined and white women since the early 1980s. The increasing rate in white women predominantly involves small (≤2 cm) and localized‐stage tumors, although a small increase in the incidence of regional‐stage tumors and those larger than five cm occurred since the early 1990s. The incidence rate among African American women stabilized during the 1990s for all breast cancers and for localized tumors. African American women are more likely than white women to be diagnosed with large tumors and distant‐stage disease. Other racial and ethnic groups have lower incidence rates than do either white or African American women. However, the proportion of disease diagnosed at advanced stage and with larger tumor size in all minorities is greater than in white persons. Death rates decreased by 2.5% per year among white women since 1990 and by 1% per year among African American women since 1991. The disparity in mortality rates between white and African American women increased progressively between 1980 and 2000, so that by 2000 the age‐standardized death rate was 32% higher in African Americans. Clinicians should be aware that 63% and 29% of breast cancers are diagnosed at local‐ and regional‐stage disease, for which the five‐year relative survival rates are 97% and 79%, respectively. This information, coupled with decreasing mortality rates and improvements in treatment, may motivate women to have regular mammographic and clinical breast examinations. Continued efforts are needed to increase the availability of high‐quality mammography and treatment to all segments of the population.

[1]  J. Samet,et al.  Geographic variation in the treatment of localized breast cancer. , 1992, The New England journal of medicine.

[2]  B A Miller,et al.  Recent trends in U.S. breast cancer incidence, survival, and mortality rates. , 1996, Journal of the National Cancer Institute.

[3]  E. Feuer,et al.  Permutation tests for joinpoint regression with applications to cancer rates. , 2000, Statistics in medicine.

[4]  Mike Clarke,et al.  Tamoxifen for early breast cancer: an overview of the randomised trials , 1998, The Lancet.

[5]  S. Edge,et al.  Patterns of breast carcinoma treatment in older women , 2000, Cancer.

[6]  E. Feuer,et al.  Trends in use of adjuvant multi-agent chemotherapy and tamoxifen for breast cancer in the United States: 1975-1999. , 2002, Journal of the National Cancer Institute.

[7]  Alicia Samuels,et al.  Cancer Statistics, 2003 , 2003, CA: a cancer journal for clinicians.

[8]  B. Armstrong Recent trends in breast‐cancer incidence and mortality in relation to changes in possible risk factors , 1976, International journal of cancer.

[9]  K. Kerlikowske,et al.  Incidence of and treatment for ductal carcinoma in situ of the breast. , 1996, JAMA.

[10]  Hyune-Ju Kim,et al.  Kim H-J, Fay MP, Feuer EJ, Midthune DN, ‘ Permutation tests for joinpoint regression with applications to cancer rates’. Statistics in Medicine 2000 19:335–351 , 2001 .

[11]  Colin B Begg,et al.  Survival of blacks and whites after a cancer diagnosis. , 2002, JAMA.

[12]  J. Madans,et al.  Use of postmenopausal hormone replacement therapy: estimates from a nationally representative cohort study. , 1997, American journal of epidemiology.

[13]  O. Brawley Disaggregating the effects of race and poverty on breast cancer outcomes. , 2002, Journal of the National Cancer Institute.

[14]  R. Tarone,et al.  Implications of birth cohort patterns in interpreting trends in breast cancer rates. , 1992, Journal of the National Cancer Institute.

[15]  B. Wójcik,et al.  Breast carcinoma survival analysis for african american and white women in an equal‐access health care system , 1998, Cancer.

[16]  Mike Clarke,et al.  Polychemotherapy for early breast cancer: an overview of the randomised trials , 1998, The Lancet.

[17]  W. P. Evans,et al.  American Cancer Society Guidelines for Breast Cancer Screening: Update 2003 , 2003, CA: a cancer journal for clinicians.

[18]  B. Hamilton,et al.  Revised birth and fertility rates for the 1990s and new rates for Hispanic populations, 2000 and 2001: United States. , 2003, National vital statistics reports : from the Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System.

[19]  B A Miller,et al.  Recent incidence trends for breast cancer in women and the relevanceof early detection: An update , 1993, CA: a cancer journal for clinicians.

[20]  K. McMasters,et al.  The use of cytokeratin staining in sentinel lymph node biopsy for breast cancer. , 2001, American journal of surgery.

[21]  L. Garfinkel,et al.  Changing trends: An overview of breast cancer incidence and mortality , 1994, Cancer.

[22]  Sue A Joslyn,et al.  Racial differences in treatment and survival from early‐stage breast carcinoma , 2002, Cancer.

[23]  L. Kessler,et al.  Factors associated with surgical and radiation therapy for early stage breast cancer in older women. , 1996, Journal of the National Cancer Institute.

[24]  U. P. S. T. Force,et al.  Chemoprevention of Breast Cancer: Recommendations and Rationale , 2002, Annals of Internal Medicine.

[25]  B. Stewart,et al.  World Cancer Report , 2003 .

[26]  R. DiClemente,et al.  Handbook of Women’s Sexual and Reproductive Health , 2002, Issues in Women’s Health.

[27]  L. Clegg,et al.  Cancer survival among US whites and minorities: a SEER (Surveillance, Epidemiology, and End Results) Program population-based study. , 2002, Archives of internal medicine.

[28]  D. May,et al.  Time to diagnosis and treatment of breast cancer: results from the National Breast and Cervical Cancer Early Detection Program, 1991-1995. , 2000, American journal of public health.

[29]  R. Langer,et al.  Influence of estrogen plus progestin on breast cancer and mammography in healthy postmenopausal women: the Women's Health Initiative Randomized Trial. , 2003, JAMA.

[30]  D. Schottenfeld,et al.  The "epidemic" of breast cancer in the U.S.--determining the factors. , 1996, Oncology.