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Persons using assistive technology might not be able to fully access information in this file. For assistance, please send e-mail to: mmwrq@cdc.gov. Type 508 Accommodation and the title of the report in the subject line of e-mail. Deaths from Breast Cancer -- United States, 1991Breast cancer is the most commonly diagnosed cancer and the second leading cause of cancer death among women in the United States (1). For 1990, the National Cancer Institute's (NCI) Surveillance, Epidemiology, and End Results Program (SEER) reported that the incidence of breast cancer was approximately 109 per 100,000 women (2). The annual incidence of breast cancer among women increased approximately 52% during 1950-1990, while the death rate increased 4% during the same period (2). This report summarizes epidemiologic information about deaths from breast cancer in 1991 and describes mortality trends during 1980-1991. Decedents for whom the underlying cause of death was breast cancer (International Classification of Diseases, Adapted, Ninth Revision, codes 174.0-174.9) were identified from public-use mortality data tapes (3). Denominators for rate calculations were derived from U.S. census population estimates (4,5). Rates were directly standardized to the age distribution of the 1970 U.S. population and were analyzed by state, age group, year, and race. To increase the precision of the rates presented, race was characterized only as "white," "black," and "other." In 1991, 43,583 women died from breast cancer; the overall death rate was 27.0 per 100,000 women (Table_1) page 279. The death rate for black women (31.9) was 19% higher than for white women (26.8). Rates for black women and white women were 2.6 times and 2.2 times higher, respectively, than that for women of other races (12.4). Since 1981, this rank order of death rates by race has been consistent. During 1980-1991, race-specific death rates for breast cancer among white women remained constant, increasing less than 1%. In comparison, from 1980 to 1991, rates for black women increased 21%, from 26.4 to 31.9 per 100,000 women, and rates for women of other races increased 29%, from 9.6 to 12.4. In 1991, death rates for breast cancer were 15-fold higher for women aged greater than or equal to 50 years (91.8) than for women aged less than 50 years (6.0) (Table_1) page 279. In both age categories, death rates were higher for black women than for white women and women of other races. Death rates varied from 17.6 in Hawaii to 35.9 in the District of Columbia (Table_2). Based on regional analysis, rates were highest in the Northeast. For white women, death rates ranged from 20.4 in Hawaii to 32.9 in New Jersey and for women of races other than white*, from 14.5 in Washington to 39.6 in the District of Columbia. For women aged less than 50 years, rates ranged from 2.8 in Alaska to 10.7 in the District of Columbia, and for women aged greater than or equal to 50 years, from 58.5 in Hawaii to 113.1 in New Jersey. Reported by: Cancer Surveillance Section, Epidemiology and Statistics Br, Div of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, CDC. Editorial NoteEditorial Note: The findings in this report indicate that, in 1991, death rates for breast cancer varied substantially by race. These variations may reflect race-specific differences in stage of disease at diagnosis, survival rates, and prevalence of risk factors for breast cancer. For example, a SEER report for 1990 ** (the most recent year for which data are available) indicated substantial differences in the 5-year relative survival rate for white women (80.5%) compared with black women (64.1%). In addition, stage-specific data from SEER *** indicated survival among white women exceeded that for black women at all stages, and among white women breast cancer was more likely to be diagnosed at an earlier stage (2). Differences in state-specific death rates for breast cancer in 1991 may reflect factors that include racial composition, socioeconomic status, and access to and use of breast cancer screening and treatment. For example, for races other than white, the rate was highest in the District of Columbia, where 97% of the female residents in this combined category were black, and lowest in Washington, where 30% of the female residents in this category were black. Established risk factors for breast cancer include family history of breast cancer, history of benign breast disease, prior history of breast cancer, exposure to ionizing radiation, early age at menarche, late age at menopause, late age at first live birth, nulliparity, white race, and high socioeconomic status (1,6). Because many of these established risk factors are not alterable, secondary prevention is the current strategy for reducing mortality associated with breast cancer. Programs to reduce breast cancer mortality should emphasize the role of routine mammography screening to detect breast cancer at earlier, more treatable stages. The importance of this approach is underscored by findings from SEER indicating a 5-year relative survival rate of 93.2% for women with local disease compared with 18.2% for women with distant disease (2). Randomized clinical trials of breast cancer screening demonstrate an approximately 30% reduction in mortality for women aged 50-69 years; however, there has been no statistically significant decrease among women aged 40- 49 years (7). For women aged greater than or equal to 50 years, routine screening with mammography and clinical breast examination has been recommended every 1-2 years (1,8). A national health objective for the year 2000 is to reduce breast cancer deaths to no more than 25.2 per 100,000 (baseline: 27.2 in 1987) (objective 16.3); specific age, racial/ethnic, and socioeconomic groups have been targeted for increases in screening (objective 16.11) (9). Recent results of the Behavioral Risk Factor Surveillance System indicate that in 1992, a median of 56% of women aged greater than or equal to 50 years reported having had a mammogram and clinical breast examination within the preceding 2 years (10). Based on the rapid increases in screening during the 1980s, breast cancer death rates could be reduced by the mid-1990s (2). References
* Because of the small number of breast cancer deaths among women in other racial/ethnic groups and small populations of these groups in some states, the categories "black" and "other races" were combined for this state-specific analysis. ** For women with breast cancer diagnosed during 1983-1989. *** For women with breast cancer diagnosed during 1983-1987. Table_1 Note: To print large tables and graphs users may have to change their printer settings to landscape and use a small font size. TABLE 1. Number of breast cancer deaths * and age-adjusted death rates +, by race & and age group -- United States, 1991 ======================================================================================================== Rate -------------------------- Age group (yrs) No. --------------- Race deaths Total <50>=50 --------------------------------------------------- White 38,250 26.8 5.7 92.0 Black 4,809 31.9 9.1 102.1 Other 519 12.4 3.7 39.0 Total 43,583 @ 27.0 6.0 91.8 --------------------------------------------------- * International Classification of Diseases, Adapted, Ninth Revision, codes 174.0-174.9. + Per 100,000 women, adjusted to the 1970 U.S. population. & To increase the precision of the rates presented, race was categorized only as "white," "black," and "other." @ Five deaths occurred among persons of unknown race. ======================================================================================================== Return to top. Table_2 Note: To print large tables and graphs users may have to change their printer settings to landscape and use a small font size. TABLE 2. Number of breast cancer deaths * and age-adjusted death rates +, by state, race, and age group -- United States, 1991 ================================================================================================== Rate --------------------------------------------------- Race --------------------- Age group (yrs) No. Other ------------------- State deaths White than white & <50>=50 Total --------------------------------------------------------------------------------------- Alabama 691 24.1 31.7 6.6 85.0 25.8 Alaska 33 24.0 @ 2.8 @ 20.2 Arizona 551 24.7 17.1 6.6 78.7 24.3 Arkansas 398 21.6 32.9 6.2 75.0 23.1 California 4,303 26.6 20.3 5.6 87.7 25.7 Colorado 505 27.3 21.0 5.9 92.5 27.1 Connecticut 615 27.4 22.4 5.8 93.0 27.2 Delaware 125 28.8 @ 4.2 @ 29.0 District of Columbia 144 @ 39.6 10.7 @ 35.9 Florida 2,629 24.9 25.1 6.2 83.2 25.1 Georgia 932 24.6 26.2 7.1 80.5 25.0 Hawaii 111 20.4 16.5 4.3 58.5 17.6 Idaho 150 25.5 @ 5.1 87.3 25.2 Illinois 2,270 30.2 31.1 6.5 104.7 30.5 Indiana 964 25.6 27.1 5.6 88.0 25.7 Iowa 554 26.4 @ 6.1 88.7 26.3 Kansas 422 24.7 18.9 5.6 82.8 24.5 Kentucky 577 24.0 30.2 5.8 81.7 24.4 Louisiana 683 24.9 32.7 7.8 86.4 27.1 Maine 220 26.2 @ 5.8 88.5 26.1 Maryland 834 27.5 32.3 6.8 96.4 28.7 Massachusetts 1,323 31.1 30.1 6.1 108.7 31.2 Michigan 1,634 27.7 32.2 5.9 97.7 28.4 Minnesota 787 27.4 33.8 5.7 95.6 27.7 Mississippi 408 22.4 30.8 5.5 85.0 25.0 Missouri 984 26.5 34.5 5.4 94.4 27.2 Montana 120 22.0 @ 3.9 79.7 22.4 Nebraska 276 25.0 @ 5.2 86.2 25.0 Nevada 165 25.0 @ 2.9 88.1 23.8 New Hampshire 203 29.7 @ 6.1 102.3 29.6 New Jersey 1,778 32.9 32.2 6.9 113.1 32.9 New Mexico 195 23.4 @ 6.1 74.4 22.8 New York 3,646 30.2 26.3 5.9 103.2 29.7 North Carolina 1,132 26.3 27.0 6.6 87.9 26.5 North Dakota 122 28.5 @ 7.1 @ 29.1 Ohio 2,023 27.3 26.7 5.6 94.0 27.3 Oklahoma 496 25.1 17.9 5.6 81.6 24.2 Oregon 487 25.3 @ 5.3 85.2 24.8 Pennsylvania 2,633 28.5 36.1 6.3 99.8 29.2 Rhode Island 237 31.4 & 8.2 103.8 31.6 South Carolina 595 25.9 33.8 7.2 92.3 28.0 South Dakota 113 20.7 @ 4.3 71.5 20.8 Tennessee 827 23.8 37.1 6.5 84.4 25.6 Texas 2,250 23.1 30.6 5.7 80.5 24.0 Utah 197 25.4 @ 4.6 87.4 24.9 Vermont 98 27.3 @ 6.1 @ 27.2 Virginia 1,050 27.8 30.1 6.7 94.8 28.2 Washington 777 26.4 14.5 5.9 86.7 25.6 West Virgina 330 25.1 @ 6.6 81.9 25.1 Wisconsin 918 27.8 20.4 5.2 96.4 27.5 Wyoming 68 26.4 @ 8.7 @ 26.0 Total 43,583 26.8 27.6 6.0 91.8 27.0 --------------------------------------------------------------------------------------- * International Classification of Diseases, Adapted, Ninth Revision, codes 174.0-174.9. + Per 100,000 women, adjusted to the 1970 U.S. population. & Because of the small number of breast cancer deaths among women in other racial/ethnic groups and small populations of these groups in some states, the categories "black" and "other races" were combined for this state-specific analysis. @ Less than 100,000 in denominator or less than five cases. ================================================================================================== Return to top. 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