Late-stage breast cancer soars among women of all ages — Why early detection is failing millions

OAK BROOK, Ill. — Five-year survival rates tell a stark story about breast cancer: 99% of women survive when the disease is caught early, but only 31% survive when it’s found after spreading. Now, a comprehensive study of over 71 million American women reveals we’re increasingly finding breast cancers too late.

This concerning trend emerged from an analysis of cancer diagnosis records spanning 2004 to 2021, published in the journal Radiology. The study found that across nearly every demographic group, diagnoses of stage IV breast cancer—cancer that has already spread to distant parts of the body—have been steadily climbing. While breast cancer remains the second leading cause of cancer death among American women after lung cancer, this research suggests we may be losing ground in early detection efforts.

“It’s important to understand that these women presented with distant (metastatic or Stage 4) breast cancer at the time of diagnosis,” says co-author Dr. Debra L. Monticciolo, past president of the American College of Radiology, in a statement. “Women with this diagnosis have a much lower survival rate and are much harder to treat.”

Most alarming is the dramatic rise among women aged 20-39, who experienced a 2.91% annual increase in late-stage diagnoses between 2004 and 2021. This age group, while having lower overall breast cancer rates, faces increasingly dire statistics when they do develop the disease.

The racial disparities revealed by the study are equally troubling. Black women faced a 55% higher rate of distant-stage breast cancer compared to White women, despite similar reported rates of mammogram usage. These findings suggest that access to high-quality care—not just screening availability—plays a crucial role in early detection and treatment outcomes.

The COVID-19 pandemic further complicated this landscape. By April 2020, breast cancer screening rates had plummeted by 87-99%. Though screening rates have begun to recover, researchers worry that missed or delayed screenings during the pandemic may lead to even more late-stage diagnoses in coming years.

Among women aged 40-74, traditionally considered the core demographic for mammogram screening, concerning patterns emerged. This group showed significant increases in distant-stage diagnoses from 2004-2010 and again from 2018-2021, with racial and ethnic minorities experiencing the steepest rises.

Asian women faced particularly striking increases, with a 2.90% annual rise in distant-stage diagnoses over the study period. Native American women showed even steeper increases through 2019, though pandemic-related disruptions have complicated more recent data analysis for this group.

The pandemic’s impact on cancer detection hit hardest among older women from minority communities. Black and Hispanic women aged 75 and older experienced dramatic drops in cancer detection during 2020, suggesting that already-vulnerable populations faced additional barriers to care during the crisis.

Several factors may be driving these trends. The United States lacks a nationally organized breast cancer screening program, leading to inconsistent guidelines and practices. The U.S. Preventive Services Task Force still discourages screening for women over age 74, despite evidence supporting the benefits of early detection. Rising obesity rates and changing reproductive patterns—including later childbearing—may also contribute to increased breast cancer risk.

These findings suggest a need to reevaluate breast cancer detection strategies, particularly for younger women and minority communities. The study’s results indicate that the current approach to screening and detection may be failing those most vulnerable to late-stage diagnosis.

“Fewer than 50% of U.S. women participate in annual breast cancer screening,” says Dr. Monticciolo. “That means we don’t have the opportunity to sweep out early-stage breast cancers in huge numbers of women, who will arrive at a later stage for diagnosis.”

Behind every percentage point increase in this research stands a woman who might have had different options had her cancer been caught earlier. While the findings paint a sobering picture, they also illuminate a path forward—showing exactly where our healthcare system needs strengthening to ensure every woman has an equal chance at early detection.