After Years of Decline, Breast Cancer Mortality Rates No Longer Falling for Some

After a long period of annual declines, breast cancer mortality rates for women younger than 40 and older than 74 have stopped falling, according to a retrospective analysis.

For women ages 20 to 39, breast cancer mortality rates decreased 2.8% per year from 1990 to 2010, but showed no decline from 2010 to 2022, with an annual percentage change (APC) of -0.01 (P=0.98), reported Debra L. Monticciolo, MD, of the Baylor Scott & White Central Texas Foundation for Imaging Research and Education in Temple, Texas, and R. Edward Hendrick, PhD, of the University of Colorado Anschutz School of Medicine in Aurora.

For women ages 75 and older, breast cancer mortality rates declined significantly from 1993 to 2013 (APC -1.26, P=0.01), but showed no evidence of decline from 2013 to 2022 (APC -0.2, P=0.24), they noted in the Journal of Breast Imaging.

However, for women ages 40 to 74, breast cancer mortality rates have decreased 1.7% to 3.9% per year from 1990 to 2022 (P<0.001), a decline that was observed in all cohorts in this age group, except Asian women.

The decline in breast cancer mortality rates starting in 1990 is likely attributed to widespread screening mammography and improvements in treatment, Monticciolo and Hendrick explained.

“It is concerning that women in age groups outside the USPSTF [U.S. Preventive Services Task Force]-recommended screening range of 40-74 years are now experiencing breast cancer mortality rates that are no longer declining after years of improvement,” they wrote, noting that rates may have stopped declining due to increasing rates of diagnoses of advanced-stage disease in these age groups.

“These results suggest that current screening and treatment strategies might be becoming less effective,” they added.

For this analysis, the authors used National Center for Health Statistics data from 1990 to 2022 for all women, by age group, and by race or ethnicity.

For all women overall, breast cancer mortality rates decreased by 43.5% over that time period, with APCs decreasing 1.66% to 3.28% per year from 1990 to 2010. However, that shrunk to a decrease of 1.23% per year from 2010 to 2022.

When broken down by race or ethnicity, most groups experienced declines in breast cancer mortality rates from 1990 to 2022.

During that period, rates decreased by 41.4% for white women, 30.3% for Hispanic women, 28.8% for Black women, and 11.8% for Asian women, while rates increased only for Native American women, by 10.1%.

However, more recent trends are unfavorable for some of these groups. Breast cancer mortality rates stopped declining since 2009 for Asian women, since 2008 for Hispanic women, and since 2005 for Native American women. In addition, Asian women ages 75 and older have experienced increasing mortality rates since 2004, with an APC of 0.73%.

Mortality rates have significantly declined for both white and Black women of all ages since the early to mid-1990s, with an APC of -1.42 for Black women and -1.05 for white women.

However, breast cancer mortality rates were higher in Black women than in white women with a ratio that was age dependent. From 2004 to 2022, the ratio of breast cancer mortality rates in Black women to white women of all ages was 1.39, and varied widely by age group: 2.04 for women ages 20 to 39 compared with 1.51 for those ages 40 to 74, and 1.13 for those ages 75 and older.

The mortality rate gap among women under the age of 40 suggests that “younger Black women are especially in need of alternatives to our current breast cancer risk assessment, screening, and treatment strategies,” observed Monticciolo and Hendrick.

The authors also evaluated stage IV disease incidence rates in Black women compared with white women at presentation and found that the stage IV incidence ratio for Black versus white women mirrored mortality rate ratios.

They noted that while a risk assessment is recommended for all women by the time they reach the age of 25, breast cancer screening is recommended for women under age 40 only when they are at higher-than-average risk.

“Our results suggest more needs to be done to ensure that younger Black women have timelier risk assessment and diagnoses,” they wrote. “Disparities in healthcare need to be considered, especially for minority populations.”

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