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Geographic Variation in Breast Cancer Mortality for White and Black Women: 1986–1995

Dr. Canto is Public Health Research Specialist, National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD.
Dr. Anderson is Medical Officer, Division of Cancer Prevention, Office of Special Population Research, National Cancer Institute, Bethesda, MD.
Dr. Brawley was Director, Office of Special Population Research, Na-tional Cancer Institute, Bethesda, MD, and is now Associate Director for Cancer Control, Winship Cancer Institute of Emory University, Atlanta, GA.

Breast cancer mortality rates have decreased during the last 20 years in the United States overall. However, declines in breast cancer mortality rates differ among individual states. This analysis ranked states from the highest to the lowest percentage change in mortality between 1986 to 1990 and 1991 to 1995. Data on white and black females were analyzed separately. Among white women, the 10 states showing the greatest percentage change in mortality during those two periods had the greatest baseline mortality in the 1986-to-1990 period. Similarly, the 10 states with the lowest percentage change in mortality had the lowest mortality rate in 1986 to 1990. In contrast, among black women, the top 10 states ranked by percentage change in mortality included either a decline or an increase. The disparities in mortality rates by state likely depend on the stage of disease at diagnoses, socioeconomic status, access to care, and adequacy of medical care.