New Study Finds Breast Cancer Deaths Down But Racial Disparities Still Exist
A new study from the American Cancer Society shows that deaths from breast cancer have declined 39 percent since 1989. But the news is better for some groups than others. The study was published in the journal CA: A Cancer Journal for Clinicians, and that top line number of a 39 percent drop in breast cancer deaths is getting most of the attention. And advances in screening for breast cancer are getting a lot of the credit.
"The bottom line is screening has been successful since we started in the early 80s" said Dr. Donald Farmer, the Medical Director at the Ann Baroco Center for Breast Health at Sacred Heart Hospital and a mammography expert at Pensacola Radiology Consultants. "We've seen a dramatic decrees in the amount of morbidity and mortality associated with breast cancer. Reason being we are picking breast cancers up at an earlier stage, so we can treat those breast cancers so that those patients have a longer life and some are even cured."
But there are other numbers in the report that point to some disparities based on race. While non-Hispanic white women are two percent more likely to be diagnosed with breast cancer than non-Hispanic black women, the black women are 42 percent more likely to die of the disease. Dr. Farmer says there could be many reasons for the disparity. "When we do detect breast cancer in the non-Hispanic black woman, the breast cancer is (usually) more advanced than what we see in the non-Hispanic white woman or the Hispanic white woman. Obviously you can easily draw a correlate with poverty and the ability (for that person) to, number one, have access to screening mammography and, number two, to pay for it. many of the patients that don't have access don't have health insurance. (Also) in rural areas it's difficult for those patients to go somewhere where they can get their screening exam done. There are, certainly genetic and cultural differences in breast cancer, genetic in particular. Black women have a tendency to have more "triple-negative" breast cancers. And we're not exactly suer why that is." Triple-negative breast cancers do not express the genes for three receptors that fuel most breast cancers. This makes it more difficult to treat and usually requires a combination of therapies.
One thing Dr. Farmer is sure of is this: screening for breast cancer saves lives. The only questions out there is when to begin. "I know the US Preventive Services Task Force guidelines have been in a state of flux, but I think the American Cancer Society as well as the American College of Radiology, the American College of Obstetrics and Gynecology and the American College of Surgeons have all basically maintained the mantra that we should start the screening exam at the age of 40. Now, bear in mind that roughly 80 percent of the cancer that we see is in women older than 50." Farmer says that when they find cancer in younger women it is usually more aggressive. "So it's kind of a double edge sword. In the past, we started screening at 35. Well we found that we weren't picking up that many cancers in the 35 to 40 age group as we are now in the 40 to 50 age group. That's good if you're not that person that has breast cancer at age 36."
And one other area where Dr. Farmer opinion differs from the current standards is with breast self-examination. "I'm probably going to date myself a little bit. Certainly I feel like there is a certain value added to breast self-exam. I'm being 'a heretic' in saying that because that's certainly not the recommendation of the American Cancer Society." Dr. Farmer says the American Cancer Society changed their view on breast self-examination because they felt many women would run to see their doctors for something they felt that was just normal changes in the breast. "I can give you a number of examples in my years of practice a woman comes in and says she felt something. And it's positive."
However one recommendation that just about all the experts agree on is this: women should get an annual mammogram beginning at age 40. And despite all the reports of changes in the health care law, all health insurance policies are required to pay for that mammogram with no deducible or co-pay.