Written by Julie
Stewart
April 1, 2025 – Advances in breast cancer screening and
treatment have saved a lot of lives over the past few decades – for some groups
more than others.
5 Must-Know Breast
Cancer Facts
What lowers your chances of getting breast cancer? Learn
this and a few more facts about this disease.
Overall, the number of Americans dying of breast cancer has
fallen by 43.5% since 1990, with consistent declines among women ages 40 to 74
– the age group that the United States Preventive Services Task Force (USPSTF)
recommends be screened every other year.
But that progress has halted for many, including younger
women (20 to 39) and older women (75 and above), according to a new study
published in the Journal of Breast Imaging.
Breast cancer deaths also stopped dropping for Native
American women, Hispanic women, and Asian women. And while death rates
continually declined in both Black and White women, disparities remain. Breast
cancer mortality rates were 39% higher in Black women than in White women.
What's Driving Breast
Cancer Deaths?
Experts have a few theories as to why breast cancer deaths
are declining for some groups but not for others.
1. Breast cancer is rising in young adults. Researchers are
noticing an alarming new trend: a rise in breast cancer (and several other
cancers, such as thyroid, liver, and colorectal cancer) among younger adults.
"Historically,
age has always been the biggest risk factor for getting cancer," said
Naomi Ko, MD, MPH, an associate professor of medicine at Boston University and
a medical oncologist at Boston Medical Center. "We really have to turn our attention to the younger
population."
Experts point to rising obesity rates, sedentary lifestyles,
and alcohol use, all of which increase cancer risk. And without routine cancer
screening in adults fewer than 40, patients and doctors can miss cancers in
their early stages, when they’re easiest to treat.
2. Younger and older women might be missing early signs.
Breast cancer death rates stopped falling for younger women in 2010 and for
older women in 2013. What was happening in the early 2010s? A shift in breast
cancer awareness, possibly influenced by changing screening guidelines.
What Happens When
Breast Cancer Spreads
The type of breast cancer plays a role in when it becomes
metastatic.
"In the late
1980s, through the 1990s and even into the early 2000s, there was a much
greater sense of awareness of breast cancer," said study author Edward
Hendrick, PhD, a clinical professor of radiology at the University of Colorado
Anschutz Medical Campus.
Public service campaigns promoting breast cancer self-exams,
where you feel your breast tissue for changes, were especially strong at that
time. People knew "if you found a
problem through self-examination or clinical examination, even without
mammography screening, that you needed to act on it fairly quickly in order to
save your life," Hendrick said.
In 2009, the USPSTF recommended against routine breast
self-exams. In 2015, the American Cancer Society stopped including clinical
breast exams by health care providers in their guidelines. The reason: There
wasn’t (and still isn’t) strong research showing that either exam saves lives.
But as a result, some of that awareness might have fallen
away, said Hendrick. So women now may not respond as readily as they used to at
a lump or other signs of breast cancer.
3. Triple-negative breast cancer remains a problem. "Breast cancer is not one
disease," said Ko. It comes in four subtypes. One of them,
triple-negative breast cancer, is particularly aggressive and deadly, with the
lowest five-year survival rate of all subtypes.
Ko and Hendrick say triple-negative breast cancer is likely
a driver of trends in breast cancer death rates, especially among young women.
It more commonly affects women under 40. Black women have double the risk of
other groups. In a recent study, researchers found that survival for
triple-negative breast cancer has not improved as much as survival for other
subtypes.
Older women can also develop it. New research from the Fred
Hutchinson Cancer Center suggests that triple-negative breast cancer is rising
in Black, Hispanic, and Asian or Pacific Islander women over 65.
4. Barriers keep some people from accessing care. Breast
cancer is most survivable when caught early. But without health insurance, you
might not get tests to spot cancer before it gets worse.
Increasing Trust in
Doctors and Breast Cancer Treatments
Do you trust your doctor when they say the benefits of your
cancer treatment outweigh the side effects and risks?
A study by Ko, published in JAMA Oncology, found that
non-White women were more likely than White women to be diagnosed with stage
III locally advanced breast cancer versus earlier stages of the disease. Lack
of insurance coverage explained 45% to 47% of the difference in risk.
"I can't
emphasize enough how having insurance and having access is a huge – it's not
all of the equation, but it's a significant amount of why we see these
disparities today," Ko said.
Discrimination and mistrust in the medical system can also
cause delays in screening and care. "If
people don't feel taken care of, or feel that they belong, or feel that they
can trust a medical system, it's harder to engage in care," she said,
noting that language barriers can also make it hard to navigate the health care
system.
5. Women 75 and older might be left out of screenings, even
when they make sense. The USPSTF guidelines recommend mammograms every other
year for women ages 40 to 74 with an average risk of breast cancer. Following
these guidelines, some doctors might not suggest screening for women over 74.
One survey of primary care providers showed that doctors considered the
patient’s health, breast cancer risk, and preferences when deciding whether to
recommend screening in women over 74. But time constraints limited some
conversations.
The argument against screening women over 74 stems from
research suggesting that the benefits of doing so are unknown. A big concern is
overdiagnosis – spotting cancers that never would have grown deadly within the
woman’s remaining years. In these cases, the stress of finding cancer and side
effects of treating it could outweigh the benefits. Research published in
Annals of Internal Medicine suggests that up to 47% of breast cancers found
from screening in women ages 75 to 84 were over-diagnosed.
But for healthy older women who likely have decades of life
left, screening might make sense. "We
know that the incidence of breast cancer continues to increase up to about age
70 and is still high for women over 70, compared to young women," said
Hendrick. "There needs to be some
way of providing screening for women of good health beyond the age of 74."
Some expert groups, like the American College of Radiology,
Society of Breast Imaging, and National Comprehensive Cancer Network, don’t
have an upper age limit on their screening guidelines.
How to Know (and
Reduce) Your Breast Cancer Risk
Don't just wait for a risk assessment – ask for one. By age
25, your doctor should check your risk factors, such as your family history of
breast cancer and the age when you got your first period. (Starting periods
before age 12 is linked with a small increase in breast cancer risk.) If you
have a strong family history, your doctor might order genetic testing for
mutations in BRCA genes linked to breast cancer (including triple-negative
breast cancer).
You can also try the National Cancer Institute’s risk
calculator, and then share the results with your doctor to start the
discussion, Hendrick suggested. If you have a high risk – a 20% or higher
likelihood of developing breast cancer – your doctor might recommend breast
cancer screening as early as age 30.
"Knowledge is
power," said Ko. "Know your
history – genetic history, cancer history, personal family history – and risk
factors."
Keep up with recommended screenings. You've heard this
before, but it's worth repeating: When detected early, breast cancer is less
likely to kill (and recur). Early-stage cancer also requires fewer treatments,
which can come with harsh side effects.
"Even though it
can feel very scary if an abnormal screen comes back," Ko said, "it's better to have screened and
caught it early than to have felt something and have to deal with it
later."
If you're over 74, ask your doctor whether screening makes
sense. "There's no magic number to 74, and I tell my trainees – that's
just a number," said Ko. She considers individual factors when deciding
whether to screen older women.
"A 74-year-old
who ran marathons and has a cardiovascular age of 64, you're going to think
very differently about their life expectancy and their comorbidities and
everything than a 74-year-old that's been sedentary, obese, has type 2 diabetes
and chronic kidney disease – that's a different 74-year-old," she
said.
Of course, you don't have to be a marathoner to warrant
screening – but because cancer treatments can have complications, the benefits
of treating an early-stage, potentially slow-growing cancer may not outweigh
the risks, particularly for people in poor health.
Don’t ignore unexplained breast changes. Experts have
shifted advice away from formal self-exams and more toward simply paying
attention during daily activities – for example, when you’re washing up in the
shower or lying down, or if a partner notices changes in your breasts when
touching them. "The majority of
patients that I see come in diagnosed because they first felt something,"
Ko said.
And keep in mind that a lump isn't the only potential sign
of cancer: swelling, pain, skin dimpling, or changes in the appearance of your
nipples can also be red flags. "Make
sure that you are aware of your own body," she said. "If you feel changes in your body or
are concerned, reach out to a provider. Get checked."
Switch doctors if necessary. In a recent study, Ko and her
colleagues found that 24% of Black women with breast cancer felt ignored in
health care settings, while 21% were treated with less respect than others. If
your doctor isn’t listening to or respecting you, seek a second opinion. "I would encourage patients: Find
people that treat you like you matter, and go to them and hang on to
them," said Ko.
Watch your drinking. "The link between alcohol and
breast cancer is consistent and really strong," Ko said. A study in the
Journal of Women’s Health showed that each alcoholic beverage women drank per
day raised their breast cancer risk by 10%. (Smoking also increases breast
cancer risk.)
Move more. Being obese or overweight is a risk factor for
breast cancer. Excess fat is linked with insulin resistance and inflammation
that might fuel breast cancer growth. Exercise can help you maintain a normal
weight. "Exercise is really
important – 150 minutes a week of moderate exercise is what I tell my
patients," Ko said.
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