Breast Cancer Mortality Rates By Race

Breast cancer is the second most common cancer in women in the United States after skin cancer.¹ Like many diseases, breast cancer rates differ by race. 

While biological factors can partly explain this, non-biological elements also contribute. 

Let’s learn more about breast cancer and mortality rates by race. 

Stages of breast cancer and the survival rate explained

The cancer stage describes how much cancer is in the body, how large the tumor is, and how much it has spread. 

TNM staging system

The American Joint Committee on Cancer (AJCC) classifies the stage of cancer with the TNM system. The medical profession widely accepts this system as standard.²

TNM stands for:

• T: The size and local spread of the tumor

• N: Whether there’s lymph node involvement

• M: Whether the tumor has spread to other areas of the body (metastasized)

Tis–T4 covers the size and extension of the primary tumor. 

For example:³

• Tis: Abnormal cells in the breast ducts that haven’t spread (ductal carcinoma in situ)

• T1: The tumor is less than 2cm

• T2: The tumor is 2–5cm

• T3: The tumor is greater than 5cm

• T4: The tumor is any size and extends to the chest wall or the skin

N 0-3 is how much cancer has spread into the regional lymph nodes. 

When doctors diagnose cancer, they can use clinical and pathological staging classification. Clinical relies on physical examination, imaging tests, and biopsies. 

Pathological staging comes once the tumor is surgically removed, combining surgical results with clinical staging classification. 

A ‘c’ is added before the N if the lymph nodes are clinically classified. If they’re pathologically classified, a ‘p’ is added before the N.⁴

For example, cN2 could mean physical exams and imaging shows some spread into the lymph nodes. 

M 0-1 is whether the tumor has metastasized into other areas of the body. 

Again, if metastasis is clinically classified, a ‘c’ is added before the M, and if it is pathologically classified, a ‘p’ is added before. 

For example, pM1 means there is surgical confirmation of distant metastasis. cM0 would mean no clinical signs or symptoms of distant metastasis. 

A pathologically classified large tumor in the breast with lymph node spread but no metastasis could be deemed T4pN3pM0. 

Stages 0-IV

Doctors can also classify breast cancer into one of five stages with TNM staging.⁵

Stage 0

• Carcinoma is in situ (Tis) with no spread to lymph nodes (N0) or other organs (M0). 

Stage I

• Stage IA: Cancer is in the breast tissue (T1) but has not spread (N0). 

• Stage IB: The cancer may have spread into local lymph nodes (N1). 

Stage II

• Stage IIA: The cancer might have grown (T0–T2) and may spread into nearby lymph nodes (N0–N1), but there’s no metastasis (M0). 

• Stage IIB: The cancer might have grown more (T2–T3) and may have spread into local lymph nodes (N0–N1), but there’s no metastasis (M0).

Stage III:

• Stage IIIA: The cancer has grown (T0–T3) and spread more into local lymph nodes (N1–N2)

• Stage IIIB: The cancer has grown more and expanded onto the chest wall (T4) and may have spread to local lymph nodes (N0–N2). 

Stage IV

Regardless of the size (T) or lymph node involvement (N), cancer is classified as Stage IV if it has metastasized into one or more other organs (M1). 

Survival rates and how to read them

Survival rates depict the percentage of people who are still alive after the diagnosis of a certain type and stage of cancer.⁶ The time frame of the survival rate starts from the time of diagnosis to some point in the future (usually five years).

Relative survival rates describe how likely this group of people with breast cancer are likely to survive after five years compared to people in the general population without cancer. 

The five-year relative survival rates for localized, regional, and distant breast cancer are 99%, 86%, and 31%, respectively.⁷

This means that 86% of women with regional breast cancer will survive the effects of their cancer at the five-year mark. Relative survival rates exclude other causes of death.  

When reading survival rates, it’s important to remember that:

• Survival rates aren’t a guarantee, but they give a good indication of the prognosis.

• They are based on large numbers of people so can’t account for individual cases. 

• Other factors can influence survival rates, including: 

• Age

• Response to treatment

• Other health conditions

• Tumor grade and other characteristics

• The type of breast cancer

The SEER database

The Surveillance, Epidemiology, and End Results (SEER) Program is run by the National Cancer Institute (NCI) to provide cancer statistics. It oversees the database that helps calculate the five-year relative survival rates. 

Rather than using the TNM system, the statistics are based on the extent of the spread, which is described as: 

• Localized, when the cancer is confined to where it started.

• Regional, if the cancer has spread to the lymph nodes (usually in the armpit).

• Distant, if the cancer has spread to other organs, such as the brain, liver, or lungs.⁸

What can statistics tell us about racial disparities in breast cancer death rates?

SEER data suggests racial disparities in breast cancer diagnosis and mortality rates.⁹

Dynamics of breast cancer progression

Over time, the dynamics of breast cancer progression have shifted. 

• Since the mid-2000s, breast cancer rates have increased by 0.5% each year.¹⁰

• Since 1989, breast cancer mortality has decreased by 43% each year.¹¹

Race and ethnicity

It’s important to understand the difference between race and ethnicity.

A race is a group of people with similar biological and physical characteristics. 

Ethnicity groups people into categories based on how they culturally identify and express themselves. 

Someone can have more than one ethnicity and race.

Race breast cancer statistics

Overall, non-Hispanic white women have the highest breast cancer rates, with an incidence of 142 per 100,000 women. 

This is followed by: 

• Non-Hispanic Black women (135 per 100,000)

• Non-Hispanic Native American women (114 per 100,000)

• Non-Hispanic Pacific Islander women (111 per 100,000)

• Hispanic women (103 per 100,000).¹²

In women under 40, Black women are more likely to get breast cancer.¹³

Despite having a lower breast cancer incidence rate, Black, Native American, and Alaska Native women have the lowest breast cancer survival rates. 

The death rates from breast cancer in Black women are approximately 40% higher than in white women despite relatively similar incidence rates.¹⁴

Triple-negative and inflammatory breast cancer in Black women

Racial disparities also exist among specific breast cancer types. 

Triple-negative and inflammatory breast cancer are more prevalent in Black women compared to white women.¹⁵ One in five Black women with breast cancer has the triple-negative type.¹⁶

Triple-negative breast cancer (TNBC) is more aggressive because it grows and spreads faster. 

TNBC cells don’t have estrogen or progesterone receptors. 

They also don’t make one of the protein receptors (HER2) found on other types of breast cancer cells, leading them to grow faster. Most critically, these missing receptors mean TNBC doesn’t respond to most conventional cancer therapies.¹⁷

Inflammatory breast cancer is when cancer cells block the lymph vessels in the breast, causing swelling and redness.¹⁸

Non-biological factors contributing to racial disparities in breast cancer mortality rates

Some of the non-biological factors that create differences in breast cancer mortality rates are:

Access to healthcare

Socioeconomic status is tied to race and ethnicity, with minority groups historically having lower socioeconomic status. 

This can affect someone’s ability to access healthcare services, and the cost of medical appointments and insurance coverage are significant barriers. 

One study found that nearly half of the disparity in stage at diagnosis is due to differences in insurance coverage.¹⁹ Lack of transportation to healthcare services can also impair access.²⁰

Lack of screening

People who have poor access to healthcare services may not receive essential cancer screening promptly. Black and Hispanic people are less likely to have mammograms than white people.²¹

Lack of screening can lead to a later diagnosis when the breast cancer has spread, contributing to a lower survival rate. Studies show that Black women are often diagnosed with breast cancer at a later stage.²²

Quality of healthcare received 

The quality of cancer healthcare remains an issue within minority groups. 

Some research has found that Black patients are more likely to be treated by doctors who lack the skills and resources to provide the best care to their patients.²³ This is potentially explained by location.

Racial bias among some healthcare workers

People who encounter racial bias from healthcare workers may be less likely to attend regular checkups or screenings due to their negative experiences and lack of trust in healthcare.²⁴

Racial bias in healthcare workers may involve failing to refer patients to specialist services, leading to a slower diagnosis and initiation of treatment. 

Poor representation in clinical trials

Clinical trials are essential for assessing the safety and benefits of potentially life-changing treatments for different demographics. 

Studies show that Black women only make up 1–3% of participants in clinical trials. This suggests there’s much less research on which treatments could benefit Black people.²⁵

Differences in treatment options available

Research has found that Black and Hispanic women are less likely to receive local treatment for curable breast cancers and combined chemotherapy and radiotherapy. They are also more likely to experience treatment delays.²⁶

Biological risk factors that affect the survival rate

Biological factors that affect the survival rate of people with breast cancer include:

Type of breast cancer

Some types of breast cancer are more aggressive than others:²⁷

• Ductal carcinoma in situ: An early, non-invasive cancer that occurs when abnormal cells grow in the breast's milk ducts

• Invasive ductal carcinoma: The most common type of breast cancer, which has spread from the lobes into the surrounding tissue

• Triple-negative breast cancer: A more aggressive breast cancer that grows and spreads faster and is more likely to return after treatment

• Inflammatory breast cancer: A rare and aggressive breast cancer that blocks the vessels in the skin of the breast

Size of tumor and degree of spread

Tumors that are 2cm or larger contain more abnormal cells. Spread into the lymph nodes increases mortality after breast cancer diagnosis.²⁸

Genetic mutations

Mutations in the BRCA1 and BRCA2 genes increase the risk of breast cancer, as they make the cells more likely to divide rapidly. 

Research has found that Ashkenazi Jewish women are more likely to have a mutation in a BRCA gene.²⁹ They are more likely to develop breast cancer, especially at a young age. 

Lifestyle factors associated with breast cancer

Smoking

There’s a weak association between smoking and breast cancer risk.³⁰

Research suggests that people who have smoked for more than ten years may be at moderately increased risk of breast cancer.³¹

Alcohol

Alcohol consumption is linked to breast cancer incidence and mortality. Research has found that:³²

• Consuming 10–15g of alcohol per day increases the risk of breast cancer.

• Consuming four or more alcoholic drinks per day is associated with increased breast cancer mortality.

Socioeconomic status

Studies have found that women with higher socioeconomic status are more likely to be diagnosed with breast cancer.³³

However, women with lower socioeconomic status are more likely to be diagnosed with more aggressive forms of premenopausal breast cancer and die from it.³⁴

These trends are similar across all racial and ethnic groups. 

Obesity

Obesity is associated with higher rates of:³⁵

• Postmenopausal breast cancer but lower risk of premenopausal breast cancer³⁶

• Breast cancer recurrence

• Breast cancer mortality 

• Other chronic health conditions that reduce overall health, the success of treatment, and cancer survival 

This is an important risk factor to consider because Black and Hispanic people have higher rates of obesity than white women.³⁷

How can I reduce my breast cancer risk?

Although it’s not possible to completely prevent breast cancer, you can take some actions to reduce your risk and improve your overall outcome. These include:

Routine screening

Screening aims to detect early signs of cancer before symptoms arise. The United States Preventive Services Task Force recommends that:³⁸

• Women aged 50–74 at average risk of breast cancer should get a mammogram every two years.

• Women aged 40–49 should consult with their doctor to decide on the best time for a mammogram. 

Women at risk of breast cancer may benefit from a mammogram. 

Reduce alcohol consumption

Alcohol increases the risk of breast cancer by possibly altering hormonal balance and promoting fat gain.³⁹

The American Cancer Society recommends completely avoiding alcohol or limiting it to a maximum of one drink per day.⁴⁰

Maintain a healthy weight

Research has found that obesity can increase breast cancer mortality.⁴¹

Weight management can directly reduce the risk of breast cancer and other chronic conditions associated with breast cancer.⁴²

Participate in regular exercise

Research shows that women with breast cancer who meet the minimum physical activity guidelines (two to two-and-a-half hours of moderate-intensity exercise each week) before diagnosis and after treatment have lower cancer recurrence and mortality rates.⁴³

However, any amount of exercise may be beneficial, as a sedentary lifestyle increases breast cancer risk.⁴⁴ Research has shown that vigorous physical activity more than three days a week is associated with lower breast cancer risk in pre and perimenopausal women.

Limit exposure to toxins

Some toxins and chemicals recommended to avoid include:⁴⁵

• BPA, found in some plastics 

• Endocrine-disrupting chemicals, such as those in cosmetics and cleaning products 

• Non-stick cookware 

• Pesticides, like glyphosate

• Heavy metals, like lead and mercury  

Review your medications

Medications such as contraceptives can increase your risk of breast cancer.⁴⁶

It’s always best to consult a doctor before stopping any medication so you can weigh the pros and cons and do so safely. 

Stop smoking

Smoking involves carcinogens that can travel to the breast tissue.⁴⁷

Some research suggests that quitting smoking is associated with improved survival among all women with breast cancer who smoke.⁴⁸

Improve your diet

Omega-3 fatty acids, fiber, vitamin D, phytoestrogens, and folate (vitamin B6) may be important nutrients to include in your diet. Aim to eat plenty of vegetables, fruits, legumes, whole grains, and lean protein sources.⁴⁹

It’s also recommended to reduce saturated and trans fats, processed food rich in sodium, sugar, and processed meat.⁵⁰

Although the data between diet and breast cancer are not perfectly clear, research found those with the highest animal fat intake were at consistently higher risk for breast cancer. Those with high fatty fish and fruit and vegetable consumption were at lower risk.⁵¹ ⁵²

The lowdown

Breast cancer cases are increasing, but more women are surviving overall due to effective screening programs and new treatments. However, there are clear racial disparities in breast cancer cases and mortality. 

Looking forward, health professionals and researchers need to work together to address systemic racial barriers to ensure minority groups are represented and can receive fast diagnoses and effective treatments to reduce disparities in survival rates. 

It’s possible to reduce your breast cancer risk by attending regular screenings, improving your lifestyle, maintaining a healthy weight, and exercising regularly. 

Frequently asked questions

Why are breast cancer rates low in Japan?

Japanese women have lower rates of breast cancer than American women. 

Some possible explanations include their lower rates of obesity and higher soy intake.⁵³ ⁵⁴ However, breast cancer rates have risen in Japan in recent years. 

What ethnic group is most at risk for breast cancer?

White women have the highest rates of breast cancer cases overall. However, Black women have higher rates of the most aggressive forms of breast cancer, including triple-negative, inflammatory, and metastatic breast cancers. 

While white women have more breast cancer cases, Black women have a higher mortality rate.