Approximately 252,710 new cases of invasive breast cancer and 63,410 cases of in situ breast carcinoma are expected to be diagnosed among US women in 2017 (Table 1 ). In addition, 40,610 women are expected to die from this disease in 2017. Eighty‐one percent of breast cancers are diagnosed among women ages 50 years and older, and 89% of breast cancer deaths occur in this age group. The median age at diagnosis for women with breast cancer is 62 years; the median age at diagnosis is younger for black women (59 years) than for white women (63 years). The median age at breast cancer death is 68 years overall (70 years for white women and 62 years for black women). 13 
 
 A woman living in the United States has a 12.4%, or a 1 in 8, lifetime risk of being diagnosed with breast cancer (Table 2 ). Lifetime risk reflects an average woman's risk over an entire lifetime, taking into account the possibility that she may die from another cause before she would have been diagnosed with breast cancer, and does not apply only to women who live to a very old age. Age‐specific probabilities for developing cancer over a 10‐year period are also provided in Table 2 . For example, the risk for a 50‐year‐old, cancer‐free woman being diagnosed with breast cancer over the next 10 years is 2.3%. Equivalently, 1 in 43 cancer‐free women who are 50 years old will be diagnosed with breast cancer by the age of 60 years. 
 
 Cause‐specific survival (ie, the probability of not dying of breast cancer within a specified number of years after diagnosis) is used instead of relative survival to describe survival in racial and ethnic minorities, because reliable estimates of life expectancy are not available for some racial/ethnic groups. For each known stage of disease, 5‐year breast cancer survival is highest for API women and lowest for NHB women (Fig. 4 ). Racial/ethnic differences in survival in part reflect the variation in the distribution of breast cancer subtypes (Fig. 3 ). 
 
 Racial and ethnic variations in breast cancer stage at diagnosis and 5‐year cause specific survival are shown in Figure 4 . NHW and API women have the highest proportions of localized breast cancers (range, 65%‐67%) and the lowest proportions of regional (range, 27%‐30%) stage disease. In contrast, NHB and Hispanic women have lower proportions of localized breast cancers (range, 57%‐59%) and higher proportions of regional (35%) stage disease. Distant‐stage disease represented 9% of diagnoses among NHB women, compared with 5% to 6% of diagnoses in other racial/ethnic groups. 
 
 Figure 3 shows racial/ethnic variation in incidence rates by breast cancer subtype. Gene expression profiling techniques have allowed researchers to identify at least 5 different molecular subtypes (luminal A, luminal B, human epidermal growth factor receptor 2 [HER2] overexpression, basal, and normal‐like tumors), which are biologically variable in presentation, response to treatment, and outcomes and may be associated with distinct etiology. 14 , 15 These molecular subtypes are approximated using routinely evaluated immunohistochemical markers, including the presence or absence of HRs (ER or PR); (HR‐positive/HR‐negative) and expression of the HER2 (HER2‐positive/HER2 negative) protein. 16 The HR‐positive/HER2 negative (luminal A) breast cancers are the most common subtype in each racial/ethnic group; however, rates range from 53 cases per 100,000 in Hispanics to 82 cases per 100,000 in NHW. Lower overall breast cancer incidence rates in AI/AN, Hispanic, and API women are primarily driven by lower rates of the HR‐positive/HER2‐negative subtype. In contrast, incidence rates for triple‐negative breast cancers (HR‐negative/HER2‐negative), most of which are the basal subtype, are twice as high in NHB women (24 per 100,000) compared with NHW women (12 per 100,000), which is the racial/ethnic group with the second highest rate. Importantly, studies suggest that the distribution of breast cancer subtypes may also vary within the broad racial/ethnic groups described here. For example, although overall rates of HR‐negative/HER2‐positive breast cancers in API women are similar to the rates in other groups, an analysis of California women by Asian ethnic subgroup reported that Korean, Filipina, Chinese, and Southeast Asian women had a higher risk of HR‐negative/HER2‐positive breast cancers compared with NHW women, whereas Japanese and American Indian women had lower risk for this subtype. 17 Racial and ethnic differences in breast cancer subtypes may reflect variation in the prevalence of breast cancer risk factors, particularly reproductive factors, which are most strongly associated with HR‐positive breast cancers 15 , 18 but also appear to reflect ancestry‐related genetic variations. 19 - 21 
 
 Female breast cancer incidence and mortality rates vary substantially by race/ethnicity in the United States (Fig. 1 ). Non‐Hispanic white (NHW) and non‐Hispanic black (NHB) women have higher breast cancer incidence and death rates than women of other race/ethnicities; API women have the lowest incidence and death rates. Although the overall breast cancer incidence rate during 2010 through 2014 was slightly (2%) lower in NHB women (125.5 per 100,000) than in NHW women (128.7 per 100,000), the breast cancer death rate during 2011 through 2015 was 42% higher in NHB women (29.5 per 100,000) than in NHW women (20.8 per 100,000). Racial differences in breast cancer incidence rates vary by age (Fig. 2 ). Compared with NHW women, NHB women have higher breast cancer incidence rates before age 40 years but lower rates at ages 65 to 84 years. NHB women are more likely to die from breast cancer at every age. 
 
 Temporal Trends 
 
 Incidence Much of the historic increase in breast cancer incidence rates reflect changes in reproductive patterns, such as delayed childbearing and having fewer children, which are recognized risk factors for breast cancer.22, 23 Incidence rates of in situ and invasive breast cancer rose rapidly during the 1980s and 1990s (Fig. 5), largely because of increased use of mammography screening in the United States. The widespread uptake of mammography screening inflated the incidence rate, because cancers were being diagnosed 1 to 3 years earlier than they would have been in the absence of screening, and screening also may have led to the detection of indolent cases. Invasive breast cancer rates stabilized between 1987 and 1994, followed by a slower increase during the late 1990s. The continued increase particularly among older women may reflect rising rates of obesity and the use of menopausal hormones, both of which increase the risk of postmenopausal breast cancer, as well as further increases in the prevalence of mammography screening.24 Around the year 2000, incidence rates began to decline among women ages 50 years and older; and, between 2002 and 2003, breast cancer rates decreased nearly 7%, likely because of the decreased use of menopausal hormones after publication of the Women's Health Initiative randomized trial results linking the use of estrogen plus progesterone menopausal hormone therapy to breast cancer and heart disease.25-27 The decline occurred primarily in white women and in those who had HR‐positive disease.26, 28 The drop in incidence may also reflect in part the small declines in mammography screening since 2000. The percentage of women aged 40 years and older who reported having a mammogram within the past 2 years increased from 29% in 1987 to 70% in 2000 and dropped to 64% in 2015.29 Figure 5 Open in figure viewerPowerPoint Trends in Female Breast Cancer Incidence Rates by Age: United States, 1975 to 2014. Rates are per 100,000 females and are age adjusted to the 2000 US standard population. Invasive incidence rates were adjusted for reporting delay. Source: Surveillance, Epidemiology, and End Results program. Trends in breast cancer incidence rates by race/ethnicity are shown in Figure 6. During 2005 through 2014 (the most recent 10 years of data available), overall breast cancer incidence rates increased among API (1.7% per year), NHB (0.4% per year), and Hispanic (0.3% per year) women but were stable among NHW and AI/AN women. Incidence rates for AI/AN women are less stable than for other racial and ethnic groups, because high‐quality data for this group are only available from limited geographic areas. We further examined breast cancer incidence trends by HR status for the 5 major US racial/ethnic groups during 2004 through 2014 (Fig. 7). In all racial/ethnic groups, incidence rates increased for HR‐positive (ER‐positive or PR‐positive) breast cancers and decreased for HR‐negative tumors. Figure 6 Open in figure viewerPowerPoint Trends in Female Breast Cancer Incidence Rates by Race/Ethnicity, United States. Rates are per 100,000 females, age adjusted to the 2000 US standard population, and adjusted for reporting delay. Rates for Hispanics and Asians/Pacific Islanders (APIs) are 3‐year moving averages. Data are not shown for American Indians/Alaska Natives because the rates were unstable, reflecting small case numbers. For Hispanics, incidence data do not include cases from the Alaska Native Registry. Source: Surveillance, Epidemiology, and End Results program. Figure 7 Open in figure viewerPowerPoint Trends in Female Breast Cancer Incidence Rates by Hormone Receptor Status and Race/Ethnicity: United States, 2004 to 2014. Rates are per 100,000 females, age adjusted to the 2000 US standard population, and adjusted for reporting delay. Average annual percent change (AAPC) during 2004 to 2014 shown in parentheses. *Indicates AAPC is signficantly different from zero, P < 0.05. AI/AN, American Indian/Alaska Native; API, Asian/Pacific Islander; HR, hormone receptor (estrogen and progesterone receptors); NHB, non‐Hispanic black; NHW, non‐Hispanic white. Source: North American Association of Central Cancer Registries, 2017. 
 
 Mortality Overall breast cancer death rates increased by 0.4% per year from 1975 to 1989 but since have decreased rapidly, for a total decline of 39% through 2015. As a result of this decline, 322,600 breast cancer deaths have been averted in US women through 2015. The decrease occurred in both younger and older women but has slowed among women younger than 50 years since 2007. Declines in breast cancer mortality rates have been attributed to both improvements in treatment (eg, adjuvant chemotherapy and hormonal therapy in the 1980s and targeted therapies in the 1990s) and early detection by mammography.30, 31 Not all women have benefited equally from these improvements, as evidenced by variation in mortality trends by race/ethnicity (Fig. 8). A striking divergence in long‐term breast cancer mortality trends between black and white women emerged in the early 1980s and continued to widen over the last several decades, but recent data suggest that the racial disparity may be stabilizing. The mortality gap that developed more than 30 years ago may reflect the unmasking of differences in tumor phenotype distribution between blacks and whites. Outcome improvements resulting from endocrine therapy with tamoxifen (which was approved by the US Food and Drug Administration in 1977) were being realized during that timeframe but to a lesser degree among black women because of their lower rates of HR‐positive disease. In 2011, the disparity peaked with death rates 44% higher in NHBs than in NHWs (mortality rate ratio [MRR], 1.44; 95% confidence interval [CI], 1.40‐1.48). The racial disparity has been relatively constant over the past several years; in 2015, breast cancer death rates were 39% higher in black women than in white women (MRR, 1.39; 95% CI, 1.35‐1.43). In addition, the most recent data indicate that breast cancer mortality rates have decreased in all major racial/ethnic groups in the United States. From 2006 through 2015, breast cancer death rates declined annually by 2.6% in AI/ANs, 1.8% in NHWs, 1.5% in NHBs, 1.4% in Hispanics, and 0.9% in APIs. Notably, the decline among AI/AN women began in 2005, more than a decade later than other racial and ethnic groups. Figure 8 Open in figure viewerPowerPoint Trends in Female Breast Cancer Mortality Rates by Race/Ethnicity, United States. Rates are per 100,000 females and are age adjusted to the 2000 US standard population. Data are not shown for American Indians/Alaska Natives because of unstable rates, reflecting small numbers of deaths. API, Asian/Pacific Islander. Source: National Center for Health Statistics, Centers for Disease Control and Prevention, 2017. 
 
 Survival More than 3.5 million US women with a history of breast cancer were alive on January 1, 2016.32 Figure 9 present trends in 5‐year relative survival for breast cancer by race and stage at diagnosis from 1975 through 1977 to 2007 through 2013. There were significant survival gains for each stage of disease among both black women and white women. The largest improvement in survival was for those with regional‐stage disease, which increased from 68% to 89% for white women and from 55% to 81% for black women. Survival gains for distant‐stage disease were larger for white women (19% to 37%) than for black women (16% to 26%). Improvements in breast cancer stage‐specific survival reflect treatment advances as well as decreases in tumor size within each stage of disease.33, 34 Figure 9 Open in figure viewerPowerPoint Trends in 5‐Year Breast Cancer Relative Survival (%) by Race and Stage at Diagnosis (1975‐1977 to 2007‐2013). Source: Surveillance, Epidemiology, and End Results program. 

 
 
 A radiologist compares an image from earlier mammogram technology to a 3-D digital mammogram in Wichita Falls, Tex. (Torin Halsey/Times Record News/AP) 
 
 Breast cancer death rates declined almost 40 percent between 1989 and 2015, averting 322,600 deaths, the American Cancer Society reported Tuesday. 
 
 Breast cancer death rates increased by 0.4 percent per year from 1975 to 1989, according to the study. After that, mortality rates decreased rapidly, for a 39 percent drop overall through 2015. The report, the latest to document a long-term reduction in breast-cancer mortality, attributed the declines to both improvements in treatments and to early detection by mammography. 
 
 Deanna Attai, a breast cancer surgeon at the University of California at Los Angeles who was not involved in the study, said the advances in treatment included much better chemotherapy regimens — developed in the 1980s and refined ever since — that are administered post-surgery to reduce the risk of recurrence. Other improvements have included tamoxifen, an anti-estrogen agent that was approved in the late 1970s; Herceptin, a drug used to treat tumors with a higher-than-normal level of a protein called HER2 and drugs called aromatase inhibitors. 
 
 More recently, more sophisticated targeted treatments are being used to treat cancer that has spread beyond the breast. 
 
 
 
 (American Cancer Society) 
 
 Even with the gains, however, the toll of the disease remains high. Breast cancer is the most common cancer diagnosed in U.S. women and the second-leading cause of cancer death after lung cancer. About 252,000 new cases of breast cancer are expected to be diagnosed in the United States this year, and more than 40,600 women are expected to die of the disease. A woman in the United States has a 12.4 percent, or 1 in 8, lifetime risk of being diagnosed with breast cancer. 
 
 Between 2006 and 2015, the study found, death rates decreased for all racial and ethnic groups tracked — non-Hispanic whites, non-Hispanic blacks, Asian/Pacific Islanders, Hispanics and American Indians/Alaska Natives. But there were substantial variations in mortality the different groups. 
 
 In 2015, the death rate for black women diagnosed with breast cancer was 39 percent higher than that for white women. While high, that's actually an improvement; the number was 44 percent higher in 2011. The black-white disparity emerged beginning in the 1980s, underscoring that black women have not shared in the screening and treatment advances that have benefited white women. One reason, the report noted, is that black women didn't benefit as much from the development of tamoxifen because they are less likely to have the kind of breast cancer, called estrogen-receptor positive, that is treated with the drug. 
 
 In seven states, the report found, the mortality rates for white women and black women in 2015 were the same. But the cancer group was cautious about interpreting those statistics, saying that in some of those states there might be too few cases to draw conclusions. However, researchers said they were confident the improvements in reducing or eliminating the racial disparity were real in at least three states: Connecticut, Delaware and Massachusetts. 
 
 “This means that there is light at the end of the tunnel,” said Carol DeSantis, director of breast and gynecological cancer surveillance research for the cancer society and the lead author of the study. “Some states are showing that they can close the gap.” 
 
 Still, the remaining black-white disparity “is not acceptable,” said Lee Schwartzberg, a medical oncologist at West Cancer Center in Germantown, Tenn. He said the gap reflects complicated social, economic and biological factors that are not yet fully understood, including insurance and employment status. In addition, black women are twice as likely as white women to develop so-called triple negative breast cancer, which can be harder to treat, the report noted. 
 
 “We have patients who get diagnosed with cancer and have difficulty making their appointments, like radiation every day for four or five weeks” because they can't take off from work, Schwartzberg said. 
 
 The “excess death rate” — the difference between the death rates of black and white women — ranged from 20 percent in Nevada to 66 percent in Louisiana, the study found. 
 
 Eighty-one percent of breast cancers are diagnosed among women ages 50 years and older, the study found, and 89 percent of breast-cancer deaths occur in that age group. The median age at diagnosis for women overall is 62. 
 
 The findings were published in CA: A Cancer Journal for Clinicians and its companion consumer publication Breast Cancer Facts & Figures. The reports are published every two years and cover the latest trends in breast cancer rates, deaths, survival and screening, by race and ethnicity. 
 
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– Some good news to share this week: Deaths from breast cancer have plummeted over a 26-year period. A report released Tuesday by the American Cancer Society shows a 39% decline in breast cancer-related deaths between 1989 and 2015, reports the Washington Post. The report notes 322,600 deaths were prevented in that period thanks to better treatment—doctors describe improvements in chemotherapy, as well as the introduction of new drugs like tamoxifen and Herceptin—and early detection through mammograms. But this doesn't mean we're in the clear. Far from it: One in eight American women is still expected to be diagnosed with breast cancer during her lifetime. In 2017, 252,710 are expected to receive that diagnosis; of those, 40,610 will die, the report suggests. Black women—who had a 39% higher risk of death from breast cancer than white women in 2015—are especially at risk. Black women have a lower rate of the type of breast cancer that is treated with tamoxifen and "a higher rate of triple-negative cancer," lead author Carol DeSantis says, per a release. But a medical oncologist tells the Post that there are also social and economic factors in play that explain why black women in Louisiana, for instance, had a 66% higher rate of death from breast cancer compared to white women. In this way, the disparity "is not acceptable," he says. DeSantis notes in the release that "increasing access to health care to low-income populations can further progress the elimination of breast cancer disparities."