A Grim Breast Cancer Milestone for Black Women

Tara Parker-Pope, New York Times, October 29, 2015

African-American women in the United States have reached a dubious milestone. For the first time, the incidence of breast cancer among black women is equal to that of white women, according to a sweeping new report from the American Cancer Society.

The finding is worrisome because breast cancer has historically been more deadly in black women than in white women, but at least it has not been as common. Now, as incidence rates equalize, data suggests that breast cancer will continue to exact a far greater toll on black women, and that the trend shows no sign of abating.

“It is a crisis,” said Marc Hurlbert, chief mission officer for the Breast Cancer Research Foundation. “The increasing incidence is unfortunate because the mortality rate for black women is already so much higher, and now if more women are getting breast cancer, then unfortunately, the number of black women dying from the disease will go up.”

{snip} By virtually every measure of the disease–age of diagnosis, age of death, stage of diagnosis–black women are at a significant disadvantage compared with white women, the data show.

The reasons for the increase are complex and are thought to be driven largely by rising obesity rates among African-American women. Researchers also believe that changes in reproductive patterns may play a role, as more African-American women delay childbirth and have fewer children. Both are recognized risk factors for breast cancer.

{snip} The median age at diagnosis is 58 for black women and 62 for white women. The median age for breast cancer death is 62 for black women and 68 for white women.

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Among white women, breast cancer incidence rates have been stable since 2004, hovering around 135 per 100,000 women. But among black women, rates have been consistently lower, ranging from 119 to 125 per 100,000. But in 2012, a startling change occurred. The incidence rate moved to 135 cases per 100,000 women for both white and black women.

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Obesity is considered a risk factor because it has been linked to an increased risk of estrogen-receptor positive breast cancers, and much of the increase in breast cancers among black women has been due largely to more cases of this type of tumor. The obesity rate in black women was 58 percent during the 2009 to 2012 period, up from 39 percent from 1999 to 2002. Meanwhile, the obesity rate among white women has stabilized at around 33 percent.

Over all, a black woman given a breast cancer diagnosis is 42 percent more likely to die from the disease than a white woman with breast cancer. {snip}

Compared with white women, black women were more likely to be found to have an aggressive form of the disease called triple negative breast cancer, which has a poorer prognosis, in part, because there are not targeted therapies to treat it. Triple negative breast cancers account for 22 percent of the cases among black women, and 11 percent among white women.

Black women also lag white women in diagnosis of estrogen-receptor positive disease, the most treatable form of breast cancer. Among white women, 76 percent of cancers diagnosed are ER positive, compared with 62 percent in black women.

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