VBCF’s Take on the Drop in Breast Cancer Mortality

You may have seen the recent Washington Post article discussing how the death rate for breast cancer has dropped 58% since 1975. And that’s amazing! Back in 1975, mammograms were difficult to access and less accurate, surgery was intensely disfiguring and often involved the removal of chest muscle in addition to breast tissue, and chemotherapy was basically the only option for medical treatment. In almost 50 years, the scientific community has learned so much more about the most common invasive cancer in women. 

When we meet people out in the community who are afraid to get screened for breast cancer because they don’t want to be diagnosed, we share how much things have changed in breast cancer treatment, even in recent decades. Doctors have more information and tools to individualize treatment and are learning more about how they can use the least amount of treatment for the greatest effect on the cancer. Breast cancer now comes with a 95%+ five-year survival rate if it hasn’t spread, and we are having more and more conversations about how to improve lives for breast cancer survivors because we now have so many of them who are living decades after their initial diagnosis. 

However, there is one very important aspect that only got a footnote in the Washington Post article that we think deserves more attention: the progress made has been unequal, and the disease appears to be changing. A more accurate statement would be that the mortality rate for older, white women with breast cancer has dropped dramatically, but there has been a less robust effect on other populations.

In the United States, medical advancements do not benefit everyone unless they are affordable. Historically, Americans with low income, Black people, and people in rural communities have had worse health outcomes due to a lack of access to regular healthcare. Prior to 2000, there was no national program for the uninsured to access free breast cancer screening and treatment.1 Prior to 2014, health insurance companies were not required to cover mammography at no cost.2 And prior to 2019 in Virginia, if you had no children or made more than $29,000 as a family of three, and if your job didn’t provide health insurance there was basically no broad health insurance coverage available to you. 

Virginia only has about five years of Medicaid expansion that offers almost every resident access, at least in theory, to regular breast cancer screening. In our brief national history of more equitable coverage, we learned that white women were, in fact, not more likely to develop breast cancer than Black women, but when provided with more equal screening opportunities, we learned the diagnosis rate is nearly identical. This is recent information; there are doctors practicing now who were trained when the prevailing belief was that Black women are less likely to develop breast cancer. Another trend of note is that with each new development in breast cancer treatment, the survival rate increases first for insured white women, then a rise is seen in other populations, sometimes years to decades later because that is when access becomes available to broader communities.3 

Let’s not forget our rural populations, which often not only have a lower median income than our more populous, urban, and suburban areas but also likely have to travel further in order to receive a mammogram in the first place. The screening tool causes a greater burden on people in rural communities because they often spend more money on gas and miss more hours of work. We also have counties in Virginia that do not have a breast imaging facility, so residents in these areas have to travel even further.

In recent years, there has also been a concerning trend of younger women being diagnosed with breast cancer. Cancer, in general, is more common as we age, and the risk for breast cancer increases in our 50s and 60s. However, women in their 30s and 40s are now being diagnosed with breast cancer at a higher rate than they had been previously. Women dealing with breast cancer at a younger age are often dealing with different challenges than women being diagnosed post-menopause. Not only is their cancer more likely to be aggressive, but they are often at earlier points in their career and earlier in building a family life, both of which can have a major financial impact on their cancer treatment and also means that cancer treatment may have a negative impact on their financial future.

On paper, we now have near-universal, free coverage of screening mammography available to Virginia residents. However, this is just the very first step in a possible breast cancer diagnosis. Every other aspect of the diagnostic, treatment, and survivorship care for breast cancer has a financial cost, which can vary hundreds of thousands of dollars between patients depending on disease course and what type of insurance coverage someone has. And unfortunately, patients are often making decisions about their healthcare that are rooted in financial need rather than medical need. 

Insurance is denying coverage for a doctor recommended medication? Guess I’m going with the medication insurance will cover that doesn’t have the same evidence behind it. Money’s tight this month? Guess I won’t refill the hormone-suppressing medication that reduces the risk of my breast cancer returning. Got a call back from the imaging center that they saw something suspicious on my mammogram and need to go back for more tests? Daycare just raised their rates, and we need new tires on the car, I don’t feel a lump, so I’m probably fine, I’ll just wait. Virginians are making these decisions every day, and even these seemingly small decisions can have a big impact, which is demonstrated in the growing body of research that a delay in treatment or diagnosis leads to an increased risk of breast cancer mortality. And Black, rural, low-income, and/or young Virginians are more likely to have to make these tough decisions about their healthcare.

What articles like these tell us is that treatments for breast cancer are out there. VBCF’s goal is to make it so that everyone has the same access to information and treatments so everyone can benefit from amazing medical advancements in breast cancer. Our work to solve this has historically been accomplished through our ongoing advocacy work. In addition, in 2022, we began partnering with healthcare systems in southwest Virginia to provide free diagnostic testing for breast cancer for those in financial need. VBCF doesn’t think cost should be a barrier to getting an early diagnosis, so while we work towards changing the law to improve access statewide, we have begun establishing partnerships with providers to offer some relief to residents. We anticipate setting up additional partnerships in the coming years until we can change our state’s policy on diagnostic screening cost and coverage so that all Virginians can access the healthcare services they need and benefit from advancements in healthcare, regardless of their financial means.

  1. https://www.cdc.gov/cancer/nbccedp/about.htm#:~:text=In%202000%2C%20Congress%20passed%20the,access%20to%20treatment%20through%20Medicaid. ↩︎
  2. https://www.cdc.gov/pcd/issues/2012/12_0069.htm#:~:text=In%202014%2C%20the%20Patient%20Protection,cancer%20screening%20without%20cost%2Dsharing. ↩︎
  3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6812853/ ↩︎

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