University of Virginia Health System

Breast Cancer Survival Rates Better, But Not for All

Breast cancer death rates continue to decline more than 2 percent annually, a long-running trend that can be traced to early detection and better treatments, according to a new American Cancer Society (ACS) report.

In 2007, about 178,480 new cases of invasive breast cancer will be diagnosed in American women, along with 62,030 cases of localized breast cancer.

The report says about 40,460 women are expected to die from breast cancer this year, second only to lung cancer for deaths caused by cancer.

Decrease in HRT Use, Cancer Screenings

The decline in overall reported breast cancer cases, starting in 2000, is likely related to two factors.

One is the decreased use of hormone replacement therapy (HRT), which has been linked to several health risks that include breast cancer.

The other factor could be potentially troubling, experts say: a decrease in mammography screening, resulting in fewer cancers being detected.

While 70 percent of women 40 and older said they had had a mammogram within the past two years in 2000, just 66 percent did in 2005.

Linda Rose, the Breast Program Manager at the University of Virginia Health System's Cancer Center, believes a decline in the number of women undergoing mammograms as scheduled is behind the decline in breast cancer cases.

"The drop most likely reflects cases that are under diagnosed or delayed in diagnosis and does not demonstrate a true decrease in the disease," she says.

Breast cancer is the second-most frequently diagnosed cancer among U.S. women, accounting for more than one in four malignancies.

From 1995 to 2004, the drop in breast cancer death rates was highest among Caucasians and Hispanics (2.4 percent per year), but lower in African Americans (1.6 percent per year).

Breast cancer death rates remained unchanged among other racial and ethnic groups, including Asian-Americans/Pacific Islanders and American Indians/Alaska natives.

Mammograms Still Best Bet

Breast cancer incidence rates have been declining by nearly 5 percent annually since 2001 in women ages 50 and older, partly due to the drop in use of hormone replacement therapy. Incidence rates in younger women, however, have remained stable since 1986.

Although breast cancer in men is rare, the incidence in males increased 1 percent a year between 1975 and 2004. The cause is unknown.

"For women concerned about the risk of developing and dying from breast cancer, probably still the most important advice is to get regular mammograms as recommended by the ACS," says report contributor Elizabeth Ward, Ph.D., director of surveillance research for the ACS.

"If you have a family history, you should be talking about that history with your doctor," Ward adds. "It may be recommended to begin screening sooner [than age 40]."

Other ways women can reduce their breast cancer risk, Ward says, include: 

• Women should try to maintain a healthy weight all through their life.
• Women should consume no more than one alcoholic beverage a day.
• Exercise is also a good way to decrease risk.

Dr. Eric P. Winer, director of the breast oncology center at the Dana-Farber Cancer Institute in Boston, says the new report contains "both good and bad news."

"It is clear that we have new diagnostic tools that have the potential to allow us to detect breast cancer at even earlier stages," says Winer. "Perhaps more importantly, we also have many new treatment strategies. These treatments, particularly if properly applied, will save lives and reduce suffering. There has been, and continues to be, a decline in death from breast cancer."

Winer adds that the report contains some troubling news, including the divergence in breast cancer death rates between Caucasian and African-American women. He says the trend "almost certainly relates to access to care and access to the best possible care."

UVA's Rose agrees.

"The inability to increase access to screening mammography may be the reason," she says.

"In some cases, the cause of this is that women did not have access to health care," adds Winer. "In other cases, it is because breast cancer can, at times, be quite aggressive and simply cannot be caught before it has spread. To combat this problem, we need greater access to care for all Americans and we need better treatment approaches."

To read a patient story, get additional information on breast cancer treatment or learn about UVA's Breast Care Program, visit www.uvahealth.com. 

UVA also offers a free, confidential risk assesment through the region's only High Risk Care program to determine if you have a higher-than-normal personal risk of developing breast or ovarian cancer. This free service is particularly encouraged for women with a strong family history of breast or ovarian cancer. To arrange the free screening, call 434-982-0808.

Women can learn more about their unique risks for heart disease - and how to better manage those risks - through Live Red, a new UVA heart-health initiative. You'll learn how heart attack symptoms can be different for women than for men, and you can take an online risk assessment to learn your personal heart disease risk factors.

There, you can sign up for Club Red, our free heart-healthy club for women. Benefits include tips from UVA healthcare providers and a gift package to help you live red in style.

Always consult your physician for more information.