Status of Breast Cancer in California
While mammo-graphy has undoubtedly contributed to the decrease in mortality, no woman diagnosed with breast cancer today, no matter how small the tumor or how early it is detected, can be told that her cancer is cured.
Breast cancer is the most common cancer among women of any race or ethnic group in California, and is second only to lung cancer in cancer related deaths. In 1997 alone, it is estimated that 18,865 women in California were diagnosed with breast cancer and 4,605 died of the disease.
The incidence of breast cancer in the state climbed steadily until 1987 during the time data were being collected (since 1973 for the San Francisco Bay and Los Angeles areas). Since 1987, rates have decreased slightly and now appear to have leveled off. Age-adjusted rates dropped from 111.8 per 100,000 in 1988 to 106 per 100,000 in 1993. These rates, however, varied markedly by race/ethnicity in the same time period, with non-Hispanic white women having the highest rate, followed by African American women, Hispanic women, and Asian American women, respectively. Among women younger than 50, however, African American women have a higher rate than white women.
Rates of death due to breast cancer have remained relatively constant in the United States during the last three decades, but have decreased approximately 14% in California since 1985 (about 2% per year). Unfortunately, this decrease has only been consistent and statistically significant for non-Hispanic white women. In addition, although African American women have a lower incidence of breast cancer than white women, the death rate is higher for African American women.
Mammography usage has increased markedly in the past decade, probably accounting in part for both the increased incidence of breast cancer and the decreased mortality. In 1987, only 46.7% of California women aged 40 and over reported ever having had a mammogram. By 1994, this figure had increased to 82.8%. Asian and Hispanic women, less educated women and those reporting a lower income, however, are less likely to have been screened and are therefore at greater risk for being diagnosed with breast cancer at a later stage. While mammography has undoubtedly contributed to the decrease in mortality, no woman diagnosed with breast cancer today, no matter how small the tumor or how early it is detected, can be told that her cancer is cured.
These data are most remarkable for the lack of significant change over time, despite advances in knowledge and in detection and treatment of breast cancer. It is hoped that the significant investment that California is now making will improve this reality in years to come.
