Published in:
01-04-2011 | Breast Oncology
The “Tipping Point” for Breast Cancer Mortality Decline Has Resulted from Size Reductions Due to Mammographic Screening
Published in: Annals of Surgical Oncology | Issue 4/2011
Login to get accessExcerpt
Considering the declining breast cancer mortality in the United States, it is apparent that a “tipping point” was reached between 1986 and 1991, most apparent after 1990. For the first time since 1930, the previously unyielding age-adjusted breast cancer mortality rate began a continuous decline, starting about 5 years after the upsurge in use of mammographic screening in the 1980s (Fig. 1).1 This mortality decline had reached 30% in the entire United States by 2007 (Fig. 2; http://www.seer.cancer.gov) and had reached as much as 48% in Delaware, 41% in Rhode Island, and 40% in Massachusetts (http://statecancerprofiles.cancer.gov), the three highest states in mammography use recorded by the 2006 Behavioral Risk Factor Surveillance System (BRFSS) telephone surveys (http://cdc.gov/brfss/). The BRFSS estimates mammography use at least every 2 years by women over the age of 40. In contrast, mortality decline has been only 11% in Utah, 12% in Mississippi, and 14% in Oklahoma, three of the four lowest states in BRFSS reports of screening incidence (Fig. 3; http://statecancerprofiles.cancer.gov). Although the BRFSS rates may be somewhat exaggerated because they are based on women’s recall, the resultant relative ranking is undoubtedly correct because survey techniques are similar across the country. States with the greatest decline in mortality are also states with high initial incidence and mortality from breast cancer due to well-established demographic features such as older age, higher socioeconomic status, and higher education level.2
Fig. 1
Annual age-adjusted cancer death rates among women for selected cancers, United States, 1930–2006. There was essentially no change in age adjusted mortality observed between 1930 and 1990, after which a continuing decline in age adjusted mortality has occurred through 2006 (Reprinted from Jemal A, Siegel R, Xu J, Ward E, Cancer statistics, 2010. CA: A Cancer Journal for Clinicians, n/a. doi:10.3322/caac.20073)
Fig. 2
Female breast cancer mortality rates from 1975 and projected rate to 2015. In 2007, mortality from breast cancer was down 30.3% from the 1991 baseline attributed to better ways to detect and treat breast cancer. The current trend to 2015 shows a 47.9% decrease from baseline. The latest joinpoint trend (1990–2007) shows a −2.2 annual percentage change (APC) in age-adjusted rates. Until over 90% of American women over age 40 are getting annual mammograms, the potential remains unrealized for a more substantial reduction in breast cancer mortality. Mortality rates are reported per 100,000 and are age-adjusted to 2000 U.S. standard population. (Reprinted from American Cancer Society analysis of female breast cancer (invasive) incidence rates: 2015 goal—15% reduction. SEER Cancer Statistics Review 1975–2007)
Fig. 3
Comparison of breast cancer mortality in states with high and low rates of mammographic screening. Note the more substantial mortality decline as ranked by the Behavioral Risk Factor Surveillance System (BRFSS) 2006 survey of state mammography use at least every 2 years in women over 40, comparing the top four states (MA = 84.8%; RI = 84.5%; DL = 83.7%; CT = 82.0%) to the bottom four states (ID = 67.3%; OK = 67.7%; MS = 67.8%; UT = 68.7%). Breast cancer mortality expressed deaths/100,000/year, and mammography screening expressed as proportion of women over 40 having a mammogram within 2 years (Graphs prepared by Jarurat Ousinasawat from data published on http://statecancerprofiles.cancer.gov)
× ![]()
× ![]()
× ![]()
…