Cancer Facts
NCI Reports Improvements in Breast Cancer Death Rate
The National Cancer Institute (NCI) announced that the breast cancer
death rate in American women continued to decline through 1993, a finding
that suggests improved breast cancer management, from early detection
to treatment, is having a beneficial effect.
Breast cancer mortality trends for White women in the United States have
improved markedly in the 1990s compared with the 1980s. For Black women,
increases in mortality persist, especially among older women, but the
overall increase has slowed significantly.
During the most recent 5-year period of available data, 1989 to 1993,
the age-adjusted breast cancer mortality rates fell approximately 6 percent
in White women and rose about 1 percent in Black women. By comparison,
from 1980 to 1989, rates increased 3 percent in White women and 16 percent
in Black women, according to data from the National Center for Health
Statistics.
"These findings are good news, but not good enough," said Health
and Human Services (HHS) Secretary Donna E. Shalala. "The Clinton
Administration will keep pursuing every opportunity for prevention, early
detection and treatment, and an effective research agenda to fight breast
cancer."
NCI Director Richard Klausner, M.D., said, "The data suggest the
trend is starting to move in a positive direction for African American
women as well as White women. Rates have declined among younger Black
women, although they are still higher than those of White women and are
improving more slowly."
The overall rate for American women has fallen about 5 percent in recent
years, dropping from 27.5 cases per 100,000 women in 1989 to 25.9 cases
in 1993. This year, an estimated 44,300 women will die of the disease
nationwide, but that estimate could prove to be too high if the trend
continues.
In both White and Black women, the greatest improvements in mortality
during the recent 5-year period were seen in younger age groups, but the
overall changes were more modest among Black women than in White women
of all ages.
Among White women, death rates declined for all decades of age between
30 to 79 years. Among Black women, rateswere down for all decades between
30 to 69 years. For women aged 30 to 39 years, rates dropped about 13
percent in Whites and 5 percent in Blacks. For women aged 40 to 49 years,
rates dropped 9 percent in Whites and 2 percent in Blacks. For women aged
50 to 59 years, rates declined 9 percent in Whites and less than 1 percent
in Blacks. For women aged 60 to 69 years, rates declined 6 percent in
Whites and less than 1 percent in Blacks. For women aged 70 to 79 years,
rates increased 5 percent in Blacks and decreased 3 percent in Whites.
For women 80 years and older, rates increased 5 percent in Blacks and
2 percent in Whites.
The median age at death for White breast cancer patients is 68 years
and 62 years for Black breast cancer patients.
Experts believe the recent decline in breast cancer mortality is partly
a result of mammography screening, which rapidly increased in the United
States during the 1980s and resulted in a shift toward the detection of
breast cancer at earlier, more curable stages. But experts say screening
cannot explain all of the decline.
"Such changes in mortality trends across a wide age range usually
indicate improvements in medical interventions, and examination of stage-specific
breast cancer incidence rates and survival rates suggests that both earlier
detection and improved treatment are likely contributing to the recent
declines in breast cancer mortality," said Robert Tarone, Ph.D.,
of NCI's Biostatistics Branch.
"Further study is required to determine the relative contribution
of early detection and improved treatment to the recent declines in breast
cancer mortality," added Brenda K. Edwards, Ph.D., director of NCI's
Cancer Control Research Program. "Research is now under way to investigate
the impact of adjuvant therapy on mortality rates."
Health authorities in the United Kingdom have also reported a steep decline
in the breast cancer death rate among women aged 55 to 69 years during
roughly the same time period. The mortality rate in this group dropped
12 percent from 1987 to 1994. This trend began at the same time as the
introduction of the United Kingdom's breast screening program, but researchers
there have concluded that it occurred too soon to be entirely a result
of screening. Instead, they attribute much of the decline to more effective
treatment, particularly the widespread adoption of tamoxifen therapy.
These results add weight to the evidence for a similar beneficial effect
of treatment advances on breast cancer mortality in American women.
Breast cancer mortality rates vary widely among racial and ethnic groups
in the United States. Hispanic, Chinese, Filipino, and Japanese women
have annual rates at or below 15 cases per 100,000; while Black, White,
and Native Hawaiian women have rates above 25 cases per 100,000.
Edwards said the racial differences in mortality rates depend on several
factors including risk of developing breast cancer, access to screening
and early detection, treatment and medical followup, and supportive care.
The NCI is investigating differential risk factors, patterns of care,
and clinical and biological prognostic factors for survival, she said,
adding that "understanding of these relationships is still incomplete."
The continued increase in breast cancer mortality rates in older women
extends a long-standing, increasing trend in breast cancer risk for women
born between 1900 to 1920, Tarone said. Researchers believe the increasing
mortality rates in this group reflect changes in various risk factors,
such as delayed childbearing early in the century.
Less well-understood is the declining mortality among women under age
40, who generally are not screened. The trend in this group appears to
reflect a recent change in risk factors above and beyond the improvements
due to medical intervention.
HHS' support for breast cancer research, prevention, and treatment has
increased from $271 million in 1993 to $476 million in 1996. Special programs
include:
The NCI's comprehensive effort to identify the genetic and biological
basis of breast cancer, characterize patterns of risk in the population,
and apply the knowledge gained through basic research to more effective
prevention and treatment strategies; The Centers for Disease Control's
National Breast and Cervical Cancer Early Detection program, which offers
free or low-cost mammography to uninsured or low-income women; The Food
and Drug Administration's quality standards for mammography services;
and The clinical practice guidelines on mammography issued by the Agency
for Health Care Policy and Research.
In addition, HHS' Health Care Financing Administration helps pay for
mammography for beneficiaries of the Medicare program. In recent years,
some 37 percent of women beneficiaries have been making use of Medicare's
mammography coverage. An ongoing HHS campaign, targeted especially at
women over age 65, aims at increasing the use of the benefit to at least
60 percent by the year 2000.
|
.gif)
