October 23, 2024, 11:03 am | Read time: 4 minutes
The figures are depressing: According to a new report by the American Cancer Society, one in eight women in the USA will develop breast cancer in their lifetime. FITBOOK editor Sophie Brünke reports on how the figures are developing, what factors influence the risk of breast cancer, and whether the situation is similar in Germany.
A lump in the breast, changes in shape and size, pain, or even changes to the skin in the breast area can be signs of the disease. Moreover, evidently, many women experience this in the course of their lives. According to the latest annual report from the American Cancer Society (ACS), the number of cases of breast cancer is increasing, particularly in women under the age of 50.1
Overview
Case numbers rising, mortality rate falling
Cases of breast cancer in women are on the rise. Between 2012 and 2021, the incidence rose by one percent per year, with a greater increase observed in women under 50 (1.4 percent per year) than in women aged 50 or older (0.7 percent per year). One in eight women in the US will be diagnosed with invasive breast cancer in their lifetime. The increased prevalence of obesity and later and fewer births are cited as possible reasons. In the period from 1980 to 2000, this effect was the other way around: at that time, significantly more women over 50 were diagnosed with breast cancer. This was attributed to the screening recommendations at the time, which were targeted at women aged 50 and over.
The report also brings positive news. It shows that although cases are increasing, mortality is falling. Since 1989, the mortality rate has fallen by 44 percent. This is due to advances in treatment and early detection. Nevertheless, the number of deaths from breast cancer predicted by the ACS is depressing. In 2024, an estimated 42,250 women in the USA will die from breast cancer, more than half of them aged 70 and over.
Racism as a risk factor
According to the report, there are differences between the ethnic groups living in the USA. Breast cancer incidence rates range from 104.1 (per 100,000 women) for Hispanic women to 137.9 for white women. Death rates range from 11.9 for Asian-Pacific American women to 26.8 for black women. In other words, while black women have a five percent lower incidence of breast cancer compared to white women, they are 38 percent more likely to die from a tumor. Alaska Native women also have a ten percent lower incidence of breast cancer and a six percent higher mortality rate, although the difference is not statistically significant. These disproportionate outcomes are partly attributed to differences in the stage of cancer at diagnosis and survival rates. These largely reflect unequal access to quality cancer screening and treatment.
Carol Mangione, an internist at the University of California, tells NPR, “Because of structural racism and health equity issues, there’s probably a regression for black women on every single part of that pathway (of diagnosis, ed.). The cumulative effect of these setbacks is a higher mortality rate among black women.”
Other factors that increase the risk of breast cancer
Most women who develop breast cancer actually have no known risk factors. However, around 30 percent of cases can be attributed to potentially modifiable risk factors. These include obesity (in postmenopausal breast cancer), lack of exercise, and alcohol consumption.
The strongest risk factors are a personal or family history of breast cancer or a personal history of lesions associated with risk, high-dose radiation to the breast, or certain inherited genetic variations. Studies have shown that 50 out of 100 women with a BRCA gene mutation will develop breast cancer by the age of 70. This compares with only seven in 100 women in the US population as a whole.2
New screening recommendations adopted
In April of this year, the US Preventive Services Task Force announced new guidelines that women should start getting regular breast cancer screenings at age 40 instead of 50. “If all women followed our new recommendation, we could reduce breast cancer mortality in the US by about 20 percent,” Mangione is quoted as saying. “This represents a significant reduction in breast cancer mortality.” She is also convinced that the new recommendations would be of great benefit to black women in particular and could eliminate ethnic inequality.
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Situation in Germany also critical
Despite the geographical distance between the USA and Germany, both countries share a Western cultural orientation. It is, therefore, worth taking a look at the breast cancer figures here in Germany. Unfortunately, they are similarly precarious. The Center for Cancer Registry Data shows that breast cancer is by far the most common cancer in women, with around 74,500 new cases every year. In Germany, too, around one in eight women will develop breast cancer in the course of their lives. It affects one in six women before the age of 50 and almost two in five women after the age of 70.3
The statutory early detection program entitles women over 30 to an annual clinical breast exam performed by their physician. Women between the ages of 50 and 75 are also entitled to a breast X-ray every two years as part of the mammography screening program.