Breast Cancer By the Numbers: What to Know and How to Protect Yourself

This year alone, the American Cancer Society estimates that 268,600 new cases of breast cancer will be diagnosed in the U.S. and that 42,260 Americans will die from it.

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Breast cancer is the second-leading cause of cancer death in women after lung cancer. It’s also estimated that a fraction of new cases in 2019 will affect men – 2,670 – and that 500 men will die from breast cancer this year.

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But despite the profound toll breast cancer continues to take on women, advances in early detection through screening, including mammograms, and treatment have steadily chipped away at death rates in recent decades. About 1 in 8 (or nearly 13%) women will develop breast cancer in their lifetime. Yet a greater understanding of what can be done not only to diagnose the cancer earlier, but also to prevent it in the first place, provides hope that more will be spared.

Declining Death Rates

Over the past three decades, the number of deaths from breast cancer have dropped steadily – declining by 40% between 1989 and 2017. “We estimate that that translates to 375,900 breast cancer deaths averted,” says Carol DeSantis, a principal scientist with the ACS and lead author of a 2019 report on breast cancer statistics.

Among the reasons for the declining cancer death rate, DeSantis and other experts note, are:

• Advancements in mammography screening – which rapidly increased through the 80s and 90s.
• Greater awareness about breast cancer and the need to be screened.
• Improved and expanded treatment advances options as variations in the disease became better understood.

In more recent years, that decline in mortality rate has slowed somewhat. Worldwide, more than 626,000 people died of breast cancer in 2018, and there were more than 2 million new cases of the disease, according to the World Health Organization. Around the globe, 13 women in every 100,000 die of breast cancer every year. That’s similar to the death rate in North America of 12.6 per 100,000.

While strides have been made to reduce breast cancer death rates, the decades-long decline in the mortality rate has slowed from an average annual decrease of 1.9% (1998 to 2011) to 1.3% (2011 to 2017), according to the ACS.

In the U.S., not all women are affected equally, either. While white women are more likely to be diagnosed with breast cancer, black women die from it at disproportionately higher rates.

“Breast cancer incidence rates are highest in whites (130.8 per 100,000), followed closely by blacks (126.7 per 100,000),” according to the 2019 breast cancer statistics report recently released by the ACS. “However, black women have the highest breast cancer death rate (28.4 per 100,000), which is 40% higher than the rate in white women (20.3 per 100,000)” and more than double the death rate for Asian/Pacific Islander women of 11.5 per 100,000.

Although the reasons for the disparity in death rates are still not well understood, research suggests that access to care likely plays a role. Black patients tend to be diagnosed with more advanced-stage breast cancer than their counterparts. And black women are more likely to develop triple-negative breast cancer, an aggressive form of the disease. In addition, social determinants related to poverty disproportionately affect black women. These include not having a primary care physician, lack of insurance and poor access to medical care.

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Understanding Survival Rates

Survival rates vary depending on the type of breast cancer a person has and how advanced the disease is when it’s detected. This is generally described in terms of the five-year survival rate, which is the percentage of people who are alive five years after they were diagnosed or started treatment. They may or may not still have the disease.

According to the ACS, the five-year survival rate after diagnosis is about 90% for all types of breast cancer. It’s higher if breast cancer is detected at an early stage, notes Dr. Julie Gralow, a professor of breast oncology at the University of Washington School of Medicine and clinical director of breast medical oncology at Seattle Cancer Care Alliance.

In fact, she notes, the survival rate is around 99% if the cancer has not spread beyond the breast at the time of diagnosis. However, for advanced stage breast cancer – cancer that’s spread to other parts of the body – the five-year survival rate is 27%. Previous research has found the five-year survival rate for triple-negative breast cancer is 77%, compared with 93% for other types of breast cancer.

With about 3.8 million people who have been diagnosed with breast cancer living in the U.S. today, experts say close follow-up care, as recommended for an individual by their health providers, is key to detect any recurrence.

Comparing survival rates across different treatments and breast cancers is tricky, but it can offer some understanding of the effectiveness of different approaches. Take, for example, a woman who has had a lumpectomy – a procedure in which a portion of the breast is surgically removed to take out cancer – plus radiation. Research finds the chance of what’s called a local recurrence, or cancer in the breast, within 10 years is 3% to 15%, according to the nonprofit breast cancer organization Susan G. Komen. Similarly, after mastectomy (where the whole breast is removed) without radiation therapy, the chance of local recurrence within five years is about 23%. Adding radiation therapy, however, helps lower recurrence to about 6%.

In regards to current breast cancer screening guidelines, the ACS currently suggests women of average risk begin having yearly mammograms at age 45 and switch to having them every other year at age 55. Other experts suggest starting routine screening at 40.

“Woman at average to low risk of breast cancer should have regular screening using digital mammograms or possibly 3D mammograms (breast tomosynthesis),” suggests Dr. Powel Brown, chair of clinical cancer prevention and professor of breast medical oncology at the University of Texas MD Anderson Cancer Center in Houston. “At MD Anderson, we recommend annual breast mammograms starting at age 40” for these patients.

Make sure you talk to your physician about your family history to see if further evaluation should be done to assess your risk for breast cancer, advises Dr. Jennifer Litton, an associate professor of breast medical oncology at the University of Texas MD Anderson Cancer Center.

For those who do have a higher genetic risk, like a BRCA1 or BRCA2 gene mutation, some consideration may be given to preventive treatment. This can range from a double mastectomy (surgically removing both breasts) to taking the drug tamoxifen, which is used in cancer treatment. “Tamoxifen has been shown to decrease the risk of developing a breast cancer in high-risk women by about 50%,” Litton notes.

Of course, such decisions aren’t made lightly, and experts say approaches – more or less aggressive – vary by the patient and require involved discussions, including to discuss the possible benefits and risks.

Lifestyle Changes

Lifestyle changes can also lower the risk of developing breast cancer.

According to the ACS, five lifestyle changes you should make include:

• Maintaining a healthy weight.
• Exercising regularly.
• Spending less time sitting.
• Drinking less – or avoid alcohol altogether.
• Avoiding or limiting hormone replacement therapy.

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All those changes can add up. In addition to excess weight and hormone replacement therapy increasing cancer risk, the ACS notes that women who have two to three alcoholic drinks a day have a 20% higher risk of developing breast cancer. A study done by the ACS also found that women who sat for six hours or more daily when they weren’t working had a 10% greater risk of developing breast cancer than those who did the same for less than three hours daily.

By making lifestyle changes, “you can lower the incidence of breast by about 50% … even if you start at age 50,” Weiss says. “We know that the steps you make in your everyday life make a difference.”

What to Know Before Your First Mammogram

Michael O. Schroeder, Staff Writer

Michael O. Schroeder has been a health editor at U.S. News since 2015. He writes health …  Read more

Sources

Powel Brown, MD; Carol DeSantis, MPH; Julie Gralow, MD; Jennifer Litton, MD; Marisa Weiss, MD

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