April 1, 2025 – Advances in breast cancer screening and treatment have saved a lot of lives over the past few decades – for some groups more than others.
Overall, the number of Americans dying of breast cancer has fallen by 43.5% since 1990, with consistent declines among women ages 40 to 74 – the age group that the United States Preventive Services Task Force (USPSTF) recommends be screened every other year.
But that progress has halted for many, including younger women (20 to 39) and older women (75 and above), according to a new study published in the Journal of Breast Imaging.
Breast cancer deaths also stopped dropping for Native American women, Hispanic women, and Asian women. And while death rates continually declined in both Black and White women, disparities remain. Breast cancer mortality rates were 39% higher in Black women than in White women.
What's Driving Breast Cancer Deaths?
Experts have a few theories as to why breast cancer deaths are declining for some groups but not for others.
1. Breast cancer is rising in young adults. Researchers are noticing an alarming new trend: a rise in breast cancer (and several other cancers, such as thyroid, liver, and colorectal cancer) among younger adults.
"Historically, age has always been the biggest risk factor for getting cancer," said Naomi Ko, MD, MPH, an associate professor of medicine at Boston University and a medical oncologist at Boston Medical Center. "We really have to turn our attention to the younger population."
Experts point to rising obesity rates, sedentary lifestyles, and alcohol use, all of which increase cancer risk. And without routine cancer screening in adults under 40, patients and doctors can miss cancers in their early stages, when they’re easiest to treat.
2. Younger and older women might be missing early signs. Breast cancer death rates stopped falling for younger women in 2010 and for older women in 2013. What was happening in the early 2010s? A shift in breast cancer awareness, possibly influenced by changing screening guidelines.
"In the late 1980s, through the 1990s and even into the early 2000s, there was a much greater sense of awareness of breast cancer," said study author Edward Hendrick, PhD, a clinical professor of radiology at the University of Colorado Anschutz Medical Campus.
Public service campaigns promoting breast cancer self-exams, where you feel your breast tissue for changes, were especially strong at that time. People knew "if you found a problem through self-examination or clinical examination, even without mammography screening, that you needed to act on it fairly quickly in order to save your life," Hendrick said.
In 2009, the USPSTF recommended against routine breast self-exams. In 2015, the American Cancer Society stopped including clinical breast exams by health care providers in their guidelines. The reason: There wasn’t (and still isn’t) strong research showing that either exam saves lives.
But as a result, some of that awareness might have fallen away, said Hendrick. So women now may not respond as readily as they used to at a lump or other signs of breast cancer.
3. Triple-negative breast cancer remains a problem. "Breast cancer is not one disease," said Ko. It comes in four subtypes. One of them, triple-negative breast cancer, is particularly aggressive and deadly, with the lowest five-year survival rate of all subtypes.
Ko and Hendrick say triple-negative breast cancer is likely a driver of trends in breast cancer death rates, especially among young women. It more commonly affects women under 40. Black women have double the risk of other groups. In a recent study, researchers found that survival for triple-negative breast cancer has not improved as much as survival for other subtypes.
Older women can also develop it. New research from the Fred Hutchinson Cancer Center suggests that triple-negative breast cancer is rising in Black, Hispanic, and Asian or Pacific Islander women over 65.
4. Barriers keep some people from accessing care. Breast cancer is most survivable when caught early. But without health insurance, you might not get tests to spot cancer before it gets worse.
A study by Ko, published in JAMA Oncology, found that non-White women were more likely than White women to be diagnosed with stage III locally advanced breast cancer versus earlier stages of the disease. Lack of insurance coverage explained 45% to 47% of the difference in risk.
"I can't emphasize enough how having insurance and having access is a huge – it's not all of the equation, but it's a significant amount of why we see these disparities today," Ko said.
Discrimination and mistrust in the medical system can also cause delays in screening and care. "If people don't feel taken care of, or feel that they belong, or feel that they can trust a medical system, it's harder to engage in care," she said, noting that language barriers can also make it hard to navigate the health care system.
5. Women 75 and older might be left out of screenings, even when they make sense. The USPSTF guidelines recommend mammograms every other year for women ages 40 to 74 with an average risk of breast cancer. Following these guidelines, some doctors might not suggest screening for women over 74. One survey of primary care providers showed that doctors considered the patient’s health, breast cancer risk, and preferences when deciding whether to recommend screening in women over 74. But time constraints limited some conversations.
The argument against screening women over 74 stems from research suggesting that the benefits of doing so are unknown. A big concern is overdiagnosis – spotting cancers that never would have grown deadly within the woman’s remaining years. In these cases, the stress of finding cancer and side effects of treating it could outweigh the benefits. Research published in Annals of Internal Medicine suggests that up to 47% of breast cancers found from screening in women ages 75 to 84 were overdiagnosed.
But for healthy older women who likely have decades of life left, screening might make sense. "We know that the incidence of breast cancer continues to increase up to about age 70 and is still high for women over 70, compared to young women," said Hendrick. "There needs to be some way of providing screening for women of good health beyond the age of 74."
Some expert groups, like the American College of Radiology, Society of Breast Imaging, and National Comprehensive Cancer Network, don’t have an upper age limit on their screening guidelines.
How to Know (and Reduce) Your Breast Cancer Risk
Don't just wait for a risk assessment – ask for one. By age 25, your doctor should check your risk factors, such as your family history of breast cancer and the age when you got your first period. (Starting periods before age 12 is linked with a small increase in breast cancer risk.) If you have a strong family history, your doctor might order genetic testing for mutations in BRCA genes linked to breast cancer (including triple-negative breast cancer).
You can also try the National Cancer Institute’s risk calculator, then share the results with your doctor to start the discussion, Hendrick suggested. If you have a high risk – a 20% or higher likelihood of developing breast cancer – your doctor might recommend breast cancer screening as early as age 30.
"Knowledge is power," said Ko. "Know your history – genetic history, cancer history, personal family history – and risk factors."
Keep up with recommended screenings. You've heard this before, but it's worth repeating: When detected early, breast cancer is less likely to kill (and recur). Early-stage cancer also requires fewer treatments, which can come with harsh side effects.
"Even though it can feel very scary if an abnormal screen comes back," Ko said, "it's better to have screened and caught it early than to have felt something and have to deal with it later."
If you're over 74, ask your doctor whether screening makes sense. "There's no magic number to 74, and I tell my trainees – that's just a number," said Ko. She considers individual factors when deciding whether to screen older women.
"A 74-year-old who ran marathons and has a cardiovascular age of 64, you're going to think very differently about their life expectancy and their comorbidities and everything than a 74-year-old that's been sedentary, obese, has type 2 diabetes and chronic kidney disease – that's a different 74-year-old," she said.
Of course, you don't have to be a marathoner to warrant screening – but because cancer treatments can have complications, the benefits of treating an early-stage, potentially slow-growing cancer may not outweigh the risks, particularly for people in poor health.
Don’t ignore unexplained breast changes. Experts have shifted advice away from formal self-exams and more toward simply paying attention during daily activities – for example, when you’re washing up in the shower or lying down, or if a partner notices changes in your breasts when touching them. "The majority of patients that I see come in diagnosed because they first felt something," Ko said.
And keep in mind that a lump isn't the only potential sign of cancer: swelling, pain, skin dimpling, or changes in the appearance of your nipples can also be red flags. "Make sure that you are aware of your own body," she said. "If you feel changes in your body or are concerned, reach out to a provider. Get checked."
Switch doctors if necessary. In a recent study, Ko and her colleagues found that 24% of Black women with breast cancer felt ignored in health care settings, while 21% were treated with less respect than others. If your doctor isn’t listening to or respecting you, seek a second opinion. "I would encourage patients: Find people that treat you like you matter, and go to them and hang on to them," said Ko.
Watch your drinking. "The link between alcohol and breast cancer is consistent and really strong," Ko said. A study in the Journal of Women’s Health showed that each alcoholic beverage women drank per day raised their breast cancer risk by 10%. (Smoking also increases breast cancer risk.)
Move more. Being obese or overweight is a risk factor for breast cancer. Excess fat is linked with insulin resistance and inflammation that might fuel breast cancer growth. Exercise can help you maintain a normal weight. "Exercise is really important – 150 minutes a week of moderate exercise is what I tell my patients," Ko said.
