ACS 2024 Report Shows Breast Cancer Equity Gap

The American Cancer Society (ACS) 2024 report emphasizes significant racial disparities in breast cancer outcomes and calls for increased efforts to improve equity in screening and treatment. | Image Credit: Atstock Productions - stock.adobe.com

The American Cancer Society (ACS) released its updated biennial report on breast cancer statistics for patients with high-quality incidence and mortality data, arguing the need for greater efforts to mitigate racial, ethnic, and social disparities with improved representation while offering access to adequate screening and treatment.¹

Breast cancer is the second leading cause of cancer death among the US female population, but it is the leading cause of cancer death in both Black and Hispanic women. A cohort study from the Georgia Cancer Registry found a 36% increase in breast cancer mortality for patients living in deprived neighborhoods.² Other research has found links between the high mortality of Black patients with breast cancer and the lack of diversity in clinical trials, including staff.³

The 2024 ACS update provides comprehensive breast cancer statistics that include incidence, mortality, trends, and survival rates.¹ Population-based data were collected from the National Cancer Institute’s Surveillance, Epidemiology, and End Results program, along with the CDC’s National Program of Cancer Registries.

Cases and Deaths

It is estimated that women who live in the US in 2024 will have 310,720 new cases of invasive breast cancer and 56,500 cases of ductal carcinoma in situ, and 42,250 women will die from breast cancer. Women 50 years and older have greater risk of invasive breast cancer cases (84%) and deaths (91%); women 70 years and older account for half of these deaths (52%).

On average, women are typically diagnosed around 62 years. However, Hispanic (57 years), Asian American and Pacific Islander (AAPI) (57 years), Black (60 years), and American Indian or Alaska Native women (60 years) are diagnosed at younger ages compared with White women (64 years).

The median age at death is 69 years, but Hispanic, AAPI, and Black women may face a higher risk of earlier death, dying at a median age of 63 to 64 years. The risk of a breast cancer diagnosis increases in women aged 70 to 79 years (4.2%), while the risk of mortality from the disease continuously increases throughout life. Less commonly, men are affected, with an estimated 2790 cases and 530 deaths predicted in 2024.

Race and Ethnicity

Breast cancer incidence and outcomes vary significantly across racial and ethnic groups. HR-positive/HER2-negative cancers are most common in White women, while Hispanic women have the lowest incidence. Black women are more likely to be diagnosed with breast cancer at later stages, often with larger, more aggressive tumors, compared with White women. They also have a higher rate of HR-negative/HER2-negative (triple-negative) breast cancer (19%) compared with other groups (9%-11%). Triple-negative breast cancers are often diagnosed at advanced stages and have limited treatment options. Black women have the lowest 5-year survival for this subtype compared with other racial and ethnic groups.

Research has not clearly defined the reasons for the variations in breast cancer characteristics, but predictions often correlate with nativity and ancestry in Black women and AAPI women. Differences in tumor types can also represent disparities driven by social determinants of health, including poverty and residential racial segregation.

“Women today are a lot less likely to die from breast cancer, but alarming disparities still remain, especially for Asian American, Pacific Islander, Native American, and Black women,” William Dahut, MD, chief scientific officer at ACS, said in a news release.⁴ “These gaps need to be rectified through systematic efforts to ensure access to high-quality screening and treatment for every woman.”⁴

Mortality rates are highest among Black women, especially for those under 75 years.¹ They have a 38% higher mortality rate compared with White women and more than double that of AAPI women.

Breast cancer incidence has been rising, especially among Hispanic and AAPI women. Screening rates are lowest in AAPI and American Indian or Alaska Native populations. Advances in treatment and early detection have contributed to reduced mortality, but disparities persist.

Black-White Mortality Disparity

Prior to the 1980s, breast cancer diagnosis and treatment were largely similar for Black and White women. However, advancements in mammography and hormone therapy led to widening racial disparities.

Black women now have a higher incidence of less treatable breast cancer subtypes and a significantly higher mortality rate. These disparities are linked to systemic racism, which limits access to quality care.

Racial and ethnic disparities in cancer outcomes are influenced by factors such as demographics, risk factors, screening, and access to care. Addressing these disparities requires confronting systemic issues and improving health care equity.

Study Limitations

The model-based projections of the study cannot track trends over time, limiting its scope. Additionally, the data did not include information on breast cancer recurrence.

“Progress against breast cancer could be accelerated by mitigating racial disparities through increased racial diversity in clinical trials as well as community partnerships and other initiatives that increase access to high-quality screening and treatment among underserved women,” the study authors concluded.

References

1. Giaquinto AN, Sung H, Newman LA, et al. Breast cancer statistics 2024. CA Cancer J Clin. Published online October 1, 2024. doi:10.3322/caac.21863
2. ‌Santoro C. Neighborhood deprivation linked to increased breast cancer deaths for White women, but not Black women. AJMC®. June 14, 2024. Accessed October 1, 2024. https://www.ajmc.com/view/neighborhood-deprivation-linked-to-increased-breast-cancer-deaths-for-white-women-but-not-black-women
3. Taye A, Elkhanany A, Stringer-Reasor E. Increasing inclusion and equity for black women in breast cancer clinical trials. Clin Adv Hematol Oncol. 2024;22(4):175-182.
4. New ACS report: breast cancer mortality continues three decade decline overall, but steeper increases in incidence for women <50 & Asian American, Pacific Islanders of all ages.News release. ACS; September 30, 2024. Accessed October 1, 2024. https://www.newswise.com/articles/new-acs-report-breast-cancer-mortality-continues-three-decade-decline-overall-but-steeper-increases-in-incidence-for-women-50-asian-american-pacific-islanders-of-all-ages/?sc=dwhr&xy=10026574