To the Editor
The article by Dr Johnson and colleagues1 demonstrated an increase in the advanced breast cancer incidence in women younger than 40 years. As illustrated in Figure 3 of the article, this increasing incidence has occurred across the 4 largest US racial/ethnic populations; however, the magnitude of the increase has not been the same across groups. The largest increases were observed for black women, followed by white women (APCs of 3.48 and 2.67, respectively).
This difference in the rates of increase suggests increasing breast cancer disparities between young black and white women. For example, the incidence rates of distant stage breast cancer in 25- to 39-year-old black and white women in the SEER’s 13 registries were 3.1 and 1.6 per 100 000 in 1992, respectively, and 6.3 and 2.3 per 100 000 in 2009.2 Thus, racial differences in these rates widened during this period from 1.5 to 4.0 per 100 000 on the absolute scale (rate difference) and from 1.9 to 2.7 on the relative scale (rate ratio). This growing racial gap in incidence suggests even greater disparities in breast cancer mortality, given that black women have significantly poorer survival after breast cancer than white women, particularly at younger ages.3,4
As the authors note, the increasing incidence in young women does not appear to be lessening over time and may be accelerating. Consequently, breast cancer disparities between young black and white women may become even more pronounced. These findings challenge researchers to continue to search for ways to reverse these trends while remembering that the remedies that improve the population health as a whole may not reduce, and may even exacerbate, health disparities if they differentially benefit different segments of the population, including racial minority and socioeconomically disadvantaged groups.5
Footnotes
Conflict of Interest Disclosures: The authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Dr Tehranifar reported receiving grants from the National Cancer Institute and the Susan B. Komen Foundation Career Catalyst Award. Dr Akinyemiju reported receiving a postdoctoral grant from the National Cancer Institute. Dr Terry reported no disclosures.
References
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