Breast Cancer is the Leading Cause of Cancer Death Among Colorado Women — Why ?

Breast cancer occurs when breast cells start growing out of control. The cancer cells typically form a tumor that often can be detected on an x-ray or felt by examining the breast for a lump. In the case of a malignant tumor, the breast cancer cells can grow to enter surrounding breast tissue, or even spread to more remote regions of the body (metastasize).

Although men can get breast cancer, it develops almost exclusively in women. In virtually any area of the body, cells can become cancerous and then spread to other regions. The summary below includes women’s breast cancer rates, along with the rates of other leading cancers in the United States, and it contrasts those with rates in Colorado. And, the abbreviated analysis that follows the summary of cancer rates, draws from additional data to form an hypothesis accounting for the differential between the rate of breast cancer deaths among Colorado women compared to that among women nationwide in the US.

Most Common Cancers Among US American Women

NOTE: The numbers in parentheses in the statistical report below are the combined rates per each 100,000 women of all races in the United States, including those of Hispanic origins.

Breast cancer — (123.9) Breast cancer is the leading cancer in the US, among women of all races, including those of Hispanic origin.

Lung cancer — (50.8) Lung cancer is the second leading cancer among black, white, American Indian, Alaskan Native, and Pacific Islander women. And, it is the third leading cancer among Hispanic women.

Colorectal cancer — (32.8) Colorectal cancer is the second leading cancer among Hispanic women. And it is the third leading cancer among black, white, American Indian, Pacific Islander, Alaska Native, and Asian women.

Most Common Causes of Cancer Death Among US American Women

Lung cancer — (34.7) Lung cancer is the leading cause of cancer deaths in the US, among black, white, American Indian, Alaskan Native, Pacific Islander, and Asian women. And, it is the second leading cause of cancer death among Hispanic women.

Breast cancer — (20.5) Breast cancer is the leading cause of cancer deaths among Hispanic women. And, it is the second leading cause of cancer death among black, white, American Indian, Alaskan Native, Pacific Islander, and Asian women.

Colorectal cancer — (11.9) Colorectal cancer is the third leading cause of cancer death among women of all races, including those of Hispanic origin.

How Widespread is Breast Cancer in the US?

Among US American women, breast cancer is the second leading cancer, exceeded only by skin cancers. The average US American woman’s risk of getting breast cancer is approximately 12%. In other words, about 1 in 8 women in the US develop breast cancer.

2017 Breast Cancer Estimates

US breast cancer estimates from The American Cancer Society for 2017 are as follows.

  • There will be approximately 252,710 new diagnoses of invasive breast cancer in US American women this year (2017).
  • There will be approximately 63,410 new diagnoses of carcinoma in situ (CIS) (the non-invasive and earliest form of breast cancer).
  • Approximately 40,610 US American women will die from breast cancer this year.

US Breast Cancer Death Trends

Breast cancer is second only to lung cancer as a leading cause of cancer death in US American women. The risk of death from breast cancer for the average woman in the US is about 2.7%, (a 1 in 37 chance of dying from breast cancer).

Women’s rate of death from breast cancer dropped by a striking 39% between 1989 and 2015. And, from 2007 to the present (2017), although rates of death from breast cancer have remained steady in women under age 50, breast cancer death rates in US women have continued to drop in women over 50.

The decreased breast cancer rate in older US American women is thought to be attributable to:

  • Increased awareness
  • Discovery of breast cancer at earlier stages of the disease (due to screening)
  • More effective treatments

Currently, there are more than three million survivors of breast cancer in the US, including women in treatment as well as those who have completed breast cancer treatment.

Benefits of Early Diagnosis and Treatment

Survival rates are significantly improved by early detection and appropriate treatment of cancer. And, improving outcomes for women with cancer, as well as cancer prevention, include measures such as:

  1. Not smoking, maintaining a healthy diet, maintaining a healthy level of regular physical activity, avoiding obesity, and otherwise maintaining a healthy lifestyle.
  2. Having the recommended cancer screening tests, such as pap tests, mammography, and colorectal screening, at intervals recommended by women’s physicians, based on general and individual factors.
  3. Starting and completing a course of the most effective known treatment, as soon after cancer is diagnosed as possible.

Cancer in Coloradocolorado welcome sign

On a positive note, over the past several years, the Colorado cancer death rates have remained relatively low, attributed to:

  • Cancer detection at earlier stages of the disease
  • Advancements in cancer treatment
  • Cessation of tobacco use
  • Other preventive measures
  • Improved treatment options

Due to the above contributors, the rate of cancer deaths has remained relatively low across the state during recent years. The exception is the rate of lung cancer deaths, which remain high among Coloradans. Across the state, helpful preventive measures have lowered cancer risks.

Breast Cancer in Colorado Women

Notwithstanding improvements outlined above, since 2004, the leading cause of death in Colorado has been cancer. The two cancers most commonly diagnosed are breast cancer in Colorado women and men’s prostate cancer.

Poverty Factors Poverty remains a significant contributor to cancer risk. In 2012, 13.6% of Coloradans were living at the poverty level. Although that percentage was lower than the US national poverty rate of 15.9% at that time, broad socioeconomic disparities remain in the state.

Among Colorado’s population of 5,420,327 people (2017), 598,736 live in poverty (11%). The 2007-2011 American Community Survey found that poverty rates in census tracts across Colorado ranged from zero residents in poverty, to over 75% living in poverty in some regions.

The relationships between poverty and cancer are predictable:

  • Poverty causes diagnoses to less often be obtained at earlier stages of cancer.
  • There are socioeconomic disparities in tobacco use.
  • Cancer screening tests are less frequently utilized by the poor.
  • The poor have more limited access to appropriate (prompt and effective) cancer treatment.

Race and Ethnicity Factors Even though much progress has been made since 1990 in reducing cancer death rates generally, imbalances in these rates remain among Colorado’s ethnic and racial populations. Race and ethnicity factors are important in evaluating relationships between cancer risk and cancer outcomes, because poverty is a significant contributor to the racial and ethnic disparities found across the population of cancer sufferers. Consider the disproportionate burden of poverty that racial and ethnic minority groups in Colorado bear, in contrast to others:

  • 5 percent of non-Hispanic Whites live in poverty.
  • 6 percent of Asian/ Pacific Islanders live in poverty.
  • 7 percent of American Indian/ Alaska Natives live in poverty.
  • 3 percent of African-Americans live in poverty.
  • 4 percent of Hispanics live in poverty.

Gender FactorsWomen continue to account for a significantly larger percentage of US Americans living in poverty. Currently, there are 12.4% of working-age women in Colorado who live in poverty (2017). The state ranks 13th in the nation in the percentage of women between ages 18 to 64 who lived below the poverty line in 2016.

Therefore, the various poverty factors discussed above commensurately apply to a larger percentage of women in the general US population and in the Coloradan population than they do to men.

Lack of Health InsuranceLack of health insurance correlates to health disparities, including cancer death rates.

  • Of uninsured Coloradans below age 65, 34% live below 138% of the US Federal Poverty Level. This demographic is more likely to have worse outcomes in cancer cases, because of reduced access to preventive care, to timely diagnosis, and to complete courses of treatment.
  • An estimated 829,000 (16%) of Coloradans were without health insurance coverage in 2011. 26% of Hispanics lacked health insurance, in contrast to 12% of non-Hispanic Whites, and 15% of other races.
  • In poorer areas of the state, Coloradans had worse survival cancer survival rates overall. This disparity was across almost all races and ethnicities, age groups, and genders.
  • In the poorer areas of the state, women had worse 5-year cancer survival rates than women in wealthier areas of Colorado, across all age groups, races, and stages of cancer diagnosis.

Why Is Breast Cancer The Leading Cause of Cancer Deaths Higher Among Colorado Women Than the National Rate?

This question of why breast cancer is the leading cause of cancer deaths among Colorado women, seems to lead us to ask—why is Colorado women’s breast cancer death rate higher than the US national rate. After all, if the Colorado rate is not significantly higher than it is nationally, then it seems that the answer to the former question is contained within the larger question of why breast cancer is the leading cause of death nationally, and finding the answer to the former is helped by the vastly more abundant statistical information to be yielded through investigation of the latter.

After all, poverty rates are commensurate with rates of uninsured residents, the latter of which are, in turn, commensurate with higher cancer death rates more generally, and Colorado’s poverty rates are reportedly not significantly different than the national average. In fact, during some years, the Colorado poverty rate reportedly dips below the national average. However, there are some statistical and other indicators that appear to lead to a possibly likely conclusion that is based on factors including poverty rates, especially among Hispanics, and women of all races.

In 2015, according to a PEW Research Center report, there were 56.5 million Hispanics in the US, which is 17.6% of the total U.S. population. Another Pew report, on Colorado’s Hispanic demographics, indicates that Colorado’s total Hispanic population is 1,136,000, which is 21% of the state population, and the 8th highest number of Hispanics in a US state. And, it’s the 7th highest Hispanic percentage of a state population in the country.

According to the report, 21% of Coloradan Hispanics are uninsured. This number is virtually the same as the CDC datum for uninsured Hispanics nationwide, which is 21.1% for Hispanics under age 65 in the US. But, the percentage of the total Coloradan population that is Hispanic is 21%, while the total percentage of US population that is Hispanic is only 17.6%, a difference of 3.4%.

  • The percentage of US Americans expected to die from women’s breast cancer in 2017—when calculated based on a 2016 population of 323,127,513, per data from the US Census bureau, and the 40,610 women expected to die nationwide from breast cancer in 2017—appears to be 1.26%.
  • The percentage of Coloradans expected to die from women’s breast cancer in 2017—calculated based on a current Colorado population of 5,540,545 million people, also per census data, and the annual number of malignant breast cancer diagnoses (3,400) in Coloradan women, and the average of overall survival rate among those women so diagnosed, across all Colorado socioeconomic demographics (87.3% survival)—appears to be about 0.00779%, or 1%.

This is a difference of 0.26% between the above Colorado and US national estimates does not align with the 3.4% difference between the total US population of Hispanics and the Coloradan total population of Hispanics who are uninsured. On the contrary, it indicates a discrepancy in numbers supporting any inferred claim that Colorado’s breast cancer death ratio is higher than the US percentage, which apparent discrepancy confuses the issue of whether or not we should be interested in comparing the Colorado rate to the US rate at all, after all, at least for a purposes of solely understanding the Colorado breast cancer death statistic.

The misalignment between the total number of uninsured Hispanics nationwide and in Colorado, and the disparity between total Hispanic residents nationwide compared to the total in Colorado, would appear, on the face of it, not to account for the differential that reportedly does in fact exist between the US national percentage of Hispanic population women’s breast cancer deaths and the Coloradan percentage, which indicates that breast cancer death is the leading cancer death cause in Colorado, while it is only the second leading cause across the US.

However, returning to the 3.4% difference between Hispanics in Colorado vs. in the entire US, and considering what that number represents in a several-percent-higher rate of additional uninsured, it would seem to follow naturally, based on all that is understood about the correlation between rates of uninsured Hispanics and rates of cancer death, that this notably higher percentage in Colorado, compared to the national average, can arguably account for up to 3.4% of any differential between the Colorado and the US national rate.

But…Why is Breast Cancer Death Higher Than Other Cancer Death Rates in Colorado?

Or, if we elect to altogether abandon the approach of contrasting the Colorado breast cancer death rate to the national rate, and simply to focus entirely on why the Colorado women’s breast cancer rate is higher than the state’s rate of other cancer deaths, the answer would be, unfortunately, that that currently appears to remain an open question. What we can say, however, is that it does appear that the rates of uninsured Hispanic women and the rates of all Colorado women living in poverty stand out as potentially key metrics.

Further, the Colorado state government’s (2001-2012) study of the problem of breast cancer death in Colorado frames the problem as one of the relationship between cancer and poverty, so the track of exploration of the issue pursued herein seems in order with at least that more other informed approach to it.

Speculative Questions About Additional Potential Contributors to Colorado Breast Cancer Death Rates

Some additional, out-of-the-box questions regarding the difference between Colorado’s higher incidence of cancer deaths compared to the national rate, which questions may or may not be worthwhile to consider, might include any to do with:

Rural livingCan the percentage of Colorado’s population who live in remote rural locations, too far from conveniently located doctors and/or treatment facilities be an important contributor? In other words, would greater numbers of the poor obtain early diagnosis and treatment if doctors and treatments were merely in closer proximity to them.

ReligionCan religious demographics in Colorado be more than a negligible contributor to the percentage of women who receive delayed diagnoses and/or treatment in the state?

ElevationCan the higher cancer death rate in Colorado be contributed to, by any meaningful part of a percentage point, by the state’s higher elevation—i.e., by any manner of complications related to the mildly greater ongoing radiation exposure of Coloradans? By the reduced oxygen levels? By the combination of the two?

Offsets by Other CancersCould it be useful to examine why other cancer deaths are as low as they are relative to breast cancer deaths in Colorado, or why other cancer deaths are as high as they are relative to breast cancer deaths nationally, as a way to get at an answer to the question of why breast cancer rates are higher than those other cancer death rates in Colorado? Or, to the question of why breast cancer death rates are lower than those other cancer rates nationally?

Dr. Kristine Eule, Denver CO

Dr. Kristine Eule is a Denver OB/GYN physician. Her professional medical team provides Denver OB/GYN examinations and the full range of gynecological services at her private modern medical office located in the Denver Tech Center. Dr. Eule‘s emphasis is on education, and on developing a healthcare partnership with each patient, to provide the most effective possible individualized lifetime care program.

Office hours are 8:30 am – 5pm, Monday – Thursday, and 8:30 – 3pm on Friday. Dr. Eule can be reached 24/7 through her answering service. Dr. Eule cross-covers with three other Denver women OB/GYNs. So, in an emergency during her absence, a qualified female doctor is always available.

For More Information

For more information about breast cancer, or to make an appointment to see Dr. Eule, contact Dr. Kristine A. Eule, MD, Denver CO, to speak to a helpful staff member. Dr. Eule serves her patients in Denver, and throughout the Denver Colorado region.