Disparities in breast cancer survival in the United States (2001-2009): Findings from the CONCORD-2 study

Abstract

Background: Reducing breast cancer incidence and achieving equity in breast cancer outcomes remains a priority for public health practitioners, health care providers, policy makers, and health advocates. Monitoring breast cancer survival can help evaluate the effectiveness of health services, quantify inequities in outcomes between states or population subgroups, and inform efforts to improve the effectiveness of cancer management and treatment.

Methods: We analyzed breast cancer survival using individual patient records from 37 statewide registries that participated in the CONCORD-2 study, covering approximately 80% of the US population. Females were diagnosed between 2001 and 2009 and were followed through December 31, 2009. Age-standardized net survival at 1 year, 3 years, and 5 years after diagnosis was estimated by state, race (white, black), stage at diagnosis, and calendar period (2001-2003 and 2004-2009).

Results: Overall, 5-year breast cancer net survival was very high (88.2%). Survival remained remarkably high from 2001 through 2009. Between 2001 and 2003, survival was 89.1% for white females and 76.9% for black females. Between 2004 and 2009, survival was 89.6% for white females and 78.4% for black females.

Conclusions: Breast cancer survival was more than 10 percentage points lower for black females than for white females, and this difference persisted over time. Reducing racial disparities in survival remains a challenge that requires broad, coordinated efforts at the federal, state, and local levels. Monitoring trends in breast cancer survival can highlight populations in need of improved cancer management and treatment. Cancer 2017;123:5100-18. Published 2017. This article is a U.S. Government work and is in the public domain in the USA.

Keywords: breast cancer; health disparities; population-based survival; trends.

Figure 1

Breast cancer 5-year age-standardized net survival (%) is illustrated for females (ages 15–99 years) diagnosed 2001–2003 and 2004–2009 along with absolute changes (%). States are grouped by US Census region. Note that data from 37 statewide cancer registries (covering 80.6% of the population) are ranked within US Census region by the survival estimate for 2004–2009. Dark bars denote states funded by the Centers for Disease Control and Prevention National Program of Cancer Registries; pale bars, states funded by the National Cancer Institute’s Surveillance, Epidemiology and End Results Program. Asterisks indicate states that are funded by both federal surveillance programs. Change (%) was not plotted if a survival estimate was not available for 1 calendar period or if 1 or more estimates were not age standardized.

Figure 2

Breast cancer 5-year age-standardized net survival (%) is illustrated for females (ages 15–99 years) by state, race, and calendar period of diagnosis. Note that the pooled US survival estimate for each calendar period is indicated by the solid horizontal line with corresponding 95.0% and 99.8% control limits (dashed lines).