Black women continue to die from breast cancer at much higher rates than white women despite an overall decline in recent deaths, according to a new Centers for Disease Control and Prevention report.
As healthcare leaders seek to move medicine toward a more personalized approach, the analysis raises one more question whether current standard breast cancer screening and treatment guidelines do enough to recognize and address such health disparities.
An average of 41,000 women died from breast cancer each year from 2010 to 2014, according to the report published Thursday in the CDC's Morbidity and Mortality Weekly Report. Despite the decrease, black women were 41% more likely to die from breast cancer than white women, with a mortality rate of 29 deaths per 100,000 compared to 20.6 deaths per 100,000.
While the death rate in those years fell among both among white women and black women, the decline was faster among white women, falling by nearly 2% a year compared to a 1.5% decrease among black women.
The difference in the declining death rate was even more dramatic among older women. While the breast cancer death rate decreased at the same pace among black and white women, the rate among white women between the ages of 60 and 69 fell by 2% a year compared to a 1% decrease among black women within the same age range.
“The good news is that overall rates of breast cancer are decreasing among black women, said Dr. Jacqueline Miller, medical director for the CDC's National Breast and Cervical Cancer Early Detection Program in a written statement. “However, when compared with white women, the likelihood that a black woman will die after a breast cancer diagnosis is still considerably higher.”
More black women are dying from breast cancer and also being diagnosed with the disease. While cases of breast cancer among white women have declined from approximately 140 cases per 100,000 women in 1999 to about 120 per 100,000 by 2013, the incidence rate among black women has steadily increased over that same period.
A more targeted approach would reduce overdiagnosis of breast cancer in cases of small benign tumors, according to a study published Wednesday in the New England Journal of Medicine.
Critics have argued that the variance in outcomes calls for researching and addressing the root causes of breast cancer specifically among black women.
While evidence shows young black women under age 40 are more likely to develop breast cancer than similarly aged women of other ethnic groups, the U.S. Preventive Services Task Force calls for routine mammogram screening once every two years for all women between the ages of 50 and 74 at average risk for the disease. The guidelines also recommend that women under age 50 can begin routine screenings if they prefer after consulting with their physician.
But there are financial issues to be considered. The guidelines for preventive tests such as mammograms largely determine whether health plans sold on the Affordable Care Act exchanges offer the services free of charge.
Without the a recommendation from USPSTF, insurers can institute cost-sharing for such services, which can discourage some women from testing.
Study researchers said more personalized medical treatments combined with community-based efforts to ensure follow-up care would bridge the racial gap.
“Public health professionals need to work in tandem with scientists and clinical researchers to monitor the successes of these newly developed therapies by assessing disparities at a population level using trends in incidence and death rates,” authors wrote.
