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Date: Tuessday, May 7, 1996 FOR IMMEDIATE RELEASE Contact: NCI press office (301) 496-6641
The National Cancer Institute announced today 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 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 in U.S. women has fallen about 5 percent in recent years, dropping from 27.5 per 100,000 women in 1989 to 25.9 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 changes were more modest in blacks than in whites of all ages.
Among white women, death rates declined for all decades of age from 30 to 79 years;
Among black women, rates were down for all decades from 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 60 to 69 years old, rates declined 6 percent in whites and less than 1 percent in blacks;
For women 70 to 79 years old, 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 for black breastcancer patients 62 years.
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 they 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 the National Cancer Institute'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 55-69 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 U.K. 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 U.S. women.
Breast cancer mortality rates vary fairly widely among racial and ethnic groups in the United States. Hispanic, Chinese, Filipino, and Japanese women have annual rates at or below 15 per 100,000; while black, white, and Native Hawaiian women have rates above 25 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 follow-up, and supportive care. 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 from 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 National Cancer Institute'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 65, aims at increasing the use of the benefit to at least 60 percent by the year 2000.
The Cancer Information Service (CIS), a program of the National Cancer Institute, provides a nationwide telephone service for cancer patients and their families, the public, and health care professionals. CIS Information specialists have extensive training in providing up-to-date and understandable information about cancer and cancer research. They can answer questions in English and Spanish and can send free printed material. In addition, CIS offices serve specific geographic areas and have information about cancer-related services and resources in their region. The toll- free number of the CIS is 1-800-4-CANCER (1-800-422-6237).
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