Overall breast cancer mortality declines, but racial inequities remain

October 17, 2024

By Erin Cristales, Vizient

If there's a figure that proves the importance of breast cancer screenings, it's 44%.

That's the rate at which, according to the American Cancer Society (ACS), breast cancer mortality has decreased from 1989 to 2022, largely due to advancements in treatment and early detection.

But there are other numbers that illustrate what can happen when access to screenings is limited.

Take, for example, zero. Even as breast cancer death rates have fallen in every racial and ethnic group since the 1990s, death rates in American Indian/Alaska Native women have not declined at all.

Or take 38% - that's how much more likely Black women are to die from breast cancer than their white counterparts despite lower incidence rates.

"In general, early-stage cancers are easier to treat and offer a better chance at survival compared to later-stage cancers," said Setu Shah, senior intelligence consultant at Sg2, a Vizient company. "The goal with all cancers is early detection. Screenings become even more important depending on factors like race and whether you're considered low or high risk."

A recent report released by the American Hospital Association - developed using data analyzed by Vizient - found that hospital performance on key patient safety and quality measures was better in the first quarter of 2024 than before the COVID-19 pandemic. One reason is the rise in preventative care as cancer screenings increase, especially those for breast, colon and cervical cancers.

According to the data, the percentage change in the volume of breast cancer screenings since Q4 2019 is 83.1%.

Why then do problems persist - and how can health systems address them?

The major issues: According to an ACS report, the incidence rate of breast cancer in women under 50 has risen by 1% each year during 2012 to 2021, outpacing the incidence in women older than 50 (0.7% per year). And racial disparities are evident, with breast cancer incidence highest in Asian American and Pacific Islander women. Additionally, the diagnosis of breast cancer at the more easily treatable localized stage is 10% lower in Black women than white women (58% versus 68%).

In May, the U.S. Preventative Services Task Force issued updated recommendations calling for mammograms every other year for people at average risk, starting at age 40.

The contributing factors: Social determinants of health (SDOH) play an important role. Women who live in communities that lack public transportation, who have little or no access to childcare, or who lack employment or insurance are far less likely to be screened for breast cancer. Trust also is a factor.

"The trust component is something healthcare providers continuously have to move the needle on," Shah said. "Many women from underserved communities distrust health systems, and providers must find ways to build better trust within their areas to provide preventative care."

What can you do to increase screenings and preventative treatment? Break down access barriers, for one. Shah recommends the following tactics:

• Consider mobile screening programs, like mobile mammography units, that extend services and outreach by bringing imaging directly to the patient. While these initiatives typically aren't reimbursed, they have the potential to increase downstream utilization of services by improving access.
• Make breast health services more convenient and less time consuming by housing all breast health care - including visits, imaging, surgery and rehab - in one site.
• Expedite time to first appointment and treatment. That means working with imaging techs, radiologists and pathologists to build or expand capacity for same-day screenings, biopsy and diagnostic testing. Better yet, organize your diagnostic services under a women's health umbrella that also includes screenings for bone density in coordination with mammogram appointments, which offers convenience and comprehensive care by addressing two needs at once.
• Hire a workforce that mirrors the demographics of your community to build trust. Intentional recruitment is key, as is assuaging fears using social media. Collaborate with your marketing team to create posts that help patients understand what to expect when they go to their first mammogram.

Other tactics to consider: Ultimately, it's important to increase breast cancer care across the board. Here are a few more ways to do so.

• Carefully consider use of next-generation imaging (SPECT, ultrasound elastography), and advanced treatment modalities such as image-guided radiation therapy (IGRT) and intraoperative radiation therapy (IORT) that expand the ability to attract and treat more patients.
• Increase capabilities to offer genetic testing and counseling. This is particularly important when treating patients with a family history of breast cancer or those at high risk. However, there are challenges, Shah notes, such as reimbursement. And, she says, "Genetic counselors can be difficult to recruit due to the growing demand in comparison with supply. But I hope we do move in the direction of increasing awareness and encouraging patients to focus on genetic makeup to better understand risk and determine the most effective treatments." Systems can explore partnerships with academic medical centers and genetic testing companies if they lack in-house genetic testing and interpretation capabilities.
• Ensure outreach to all patient populations. Though male breast cancer makes up only 1% of total cases, that still translates to roughly 2,800 men per year in the U.S. who are diagnosed. Systems should consider the most effective ways to message the importance of screening to male patients, as well as to LGBTQ+ patients. For instance, Mayo Clinic recently launched Rainbows, an LGBTQ+-focused breast cancer clinic designed to eradicate the disparities in cancer care among that patient population. The ACS reported that society-derived stressors experienced among the LGBTQ+ community has led to lower rates of timely screening and higher rates of infection with cancer-causing viruses, health risk behaviors, avoidance and mistrust of medical settings.

At the end of the day, Shah said, the biggest issues health systems must address to ensure increased screenings and more timely diagnosis are access and integration.

"If you look at the 44% decrease in mortality statistic, it means that many survivors will live the rest of their lives with long-term side effects from treatments like chemotherapy, radiation or a mastectomy," she said. "How do you process getting breast cancer at age 45? And what happens when you add in other health concerns such as bone health that disproportionately affect women? So, health systems have a responsibility to make breast cancer screenings accessible, quick and affordable so cancers can be detected early, and patients can avoid any unnecessary hardships."

Learn more about how Vizient advances health equityand discover Sg2's approach to service line optimization.