Breast Cancer in Ohio 2022

October 2022

Incidence and Mortality

New Cases
Key Findings
Breast cancer is the most common cancer among women
and Populations in Ohio, accounting for 29% of all new female invasive
at High Risk cancer cases (incidence) reported to the Ohio Cancer
Incidence Surveillance System (OCISS) during 2015-2019. An
• An average of 9,871 invasive and 2,079 in situ average of 9,871 new cases of invasive female breast cancer
female breast cancer cases occurred each were diagnosed each year in Ohio during this five-year
year in Ohio during 2015-2019. period, at an average annual age-adjusted incidence rate
of 130.6 per 100,000 females, compared with the U.S. rate
• In Ohio, breast cancer occurred most often of 128.3 per 100,000. In Ohio, the breast cancer incidence
among women ages 65-74 years. rate was higher among white women (131.3 per 100,000)
• Female breast cancer incidence rates in Ohio than Black women (125.5 per 100,000) and Asian American
were higher in counties with or adjacent to and Pacific Islander women (85.2 per 100,000), and higher
large cities. among those age 65 and older. In addition, an average of
2,079 in situ breast cancer cases were diagnosed among
• Breast cancer incidence rates were relatively
women in Ohio in 2015-2019. This report focuses on female
stable for both white women and Black
breast cancer; however, men can also get breast cancer. An
women in Ohio from 1996 to 2019, while
average of 78 men were diagnosed with breast cancer each
mortality rates decreased 37% for both white
year in Ohio in 2015-2019, with a corresponding rate of 1.1
and Black women during this time period.
per 100,000 males.
• In Ohio, approximately 72% of female breast
cancers were diagnosed at an early stage in Deaths
2015-2019.
Breast cancer ranks as the second leading cause of cancer
• The five-year relative survival for breast death among women in Ohio after lung and bronchus
cancer was nearly 100% when diagnosed at cancer. Breast cancer accounted for 14% of all cancer-
an early stage, but only 31% when the cancer related deaths in Ohio during 2015-2019. An average of
was diagnosed at the latest (distant) stage. 1,743 deaths from breast cancer occurred each year in Ohio
during this period (Table 1). Ohio’s female breast cancer
• Infiltrating ductal carcinoma, which begins
mortality rate of 21.6 per 100,000 was 9% higher than the
in the lining of the milk ducts, is the most
U.S. rate of 19.9 per 100,000. In Ohio, the female breast
common type of invasive breast cancer, while
cancer mortality rate was highest among Black women
ductal carcinoma in situ (DCIS) is the most
(27.8 per 100,000) and lowest among Asian American and
common non-invasive type.
Pacific Islander women (10.8 per 100,000). More deaths
• In 2020, 78.3% of Ohio women ages 50-74 occurred among women age 65 and older, who had a
years reported having a mammogram in the mortality rate almost 10 times higher than women younger
past two years. than 65.
Table 1. Average Annual Number and Age-adjusted Rates of Female Breast Cancer Cases and Deaths
per 100,000, Ohio and the United States, 2015-2019
Incidence Mortality
Ohio Cases Ohio Rate U.S. Rate Ohio Deaths Ohio Rate U.S. Rate
Total 9,871 130.6 128.3 1,743 21.6 19.9
White 8,626 131.3 130.2 1,485 21.0 19.4
Race Black 1,054 125.5 125.9 236 27.8 27.1
Asian/Pacific Islander 117 85.2 106.9 14 10.8 11.6
Age <65 5,004 84.0 84.8 632 10.2 9.6
Group 65+ 4,868 453.0 428.9 1,111 100.5 91.1
Source: Ohio Cancer Incidence Surveillance System and Bureau of Vital Statistics, Ohio Department of Health, 2022; Surveillance, Epidemiology, and End Results
Program, National Cancer Institute, 2022.

Female Breast Cancer Incidence by Age Group

Figure 1. Percentage of Female Breast Cancer Cases by Age Group, Ohio, 2015-2019
35%

30% 28.1%
26.0%
25%

20%
16.5% 15.6%
15%

10% 6.6%
5.6%
5%
1.6%
0.0%
0%
<20 20-34 35-44 45-54 55-64 65-74 75-84 85+
Age Group
Source: Ohio Cancer Incidence Surveillance System, Ohio Department of Health, 2022.
As shown in Figure 1, breast cancer in Ohio was most frequently diagnosed among women ages 65-74 years (28.1%).

Female Breast Cancer Mortality by Age Group

Figure 2. Percentage of Female Breast Cancer Deaths by Age Group, Ohio, 2015-2019
35%
30%
24.5%
25%
20.2% 21.1% 18.1%
20%
15%
11.3%
10%
5% 3.8%
0.9%
0.0%
0%
<20 20-34 35-44 45-54 55-64 65-74 75-84 85+
Age Group
Source: Ohio Cancer Incidence Surveillance System, Ohio Department of Health, 2022.
As shown in Figure 2, deaths due to breast cancer in Ohio occurred most often among women ages 65-74 years (24.5%).

Breast Cancer in Ohio | 2

Female Breast Cancer Incidence by County
Figure 3. Average Annual Age-adjusted Incidence Rates of Female Breast Cancer per 100,000
by County of Residence, Ohio, 2015-2019

Lake
139.9 Ashtabula
Fulton Lucas 121.3
Williams 122.7
116.9 Ottawa
117.1 Geauga
132.9
Cuyahoga 144.0
Defiance Wood Sandusky Erie 135.8
Henry Lorain Trumbull
107.2 125.1 145.1 115.3
120.4 134.7 118.5
Portage
Seneca Huron
Paulding Medina Summit 126.8
141.2 135.6 134.6 Mahoning
99.5 Putnam Hancock 136.1
134.0 124.1 122.9
Van Wert Crawford Ashland
Wyandot 117.4 Wayne Stark Columbiana
94.3 96.9
Allen 87.3 Richland 127.8 125.2 124.1
120.6 Hardin 119.1
122.7 Marion Carroll
Auglaize 130.8 Holmes
Mercer Morrow 83.3 121.7
120.1 Jefferson
114.5 116.6 Knox
Logan 118.3 Tuscarawas 118.8
Shelby 114.2 Union Coshocton 115.0 Harrison
115.4 110.4 Delaware 102.8 133.1
141.5
Darke Champaign
Miami Licking Guernsey
110.6 116.8 Belmont
137.8 147.8 93.5
Franklin Muskingum
123.5
Clark Madison 136.7 139.1
146.7 123.2 Noble
Preble Montgomery Monroe
Fairfield Perry 112.0
124.9 144.3 Greene 127.7 108.7
Pickaway 129.0 Morgan
137.3 110.0
Fayette Hocking 134.3 Washington
Butler 137.0 115.2 132.4
135.1 Warren Clinton Ross Athens
137.7 129.1 117.6 Vinton 104.3
107.7
Hamilton Highland
138.0 Meigs
114.8 Pike 108.8
Clermont Rate per 100,000 Females
136.0 Jackson
132.7
114.7
Brown Scioto Gallia 83.3 - 114.5
99.3 Adams 110.8 97.1 114.6 - 122.7
102.8
Lawrence 122.8 - 134.6
133.7 134.7 - 147.8

Ohio Rate: 130.6

U.S. Rate: 128.3

Source: Ohio Cancer Incidence Surveillance System, Ohio Department of Health, 2022. Each category represents approximately 25% of the 88 Ohio counties.

Incidence rates for female breast cancer in 2015-2019 tended to be higher in counties with or adjacent to large cities,
including Cleveland (northeastern Ohio counties), Columbus (central Ohio counties), and Cincinnati and Dayton
(southwestern Ohio counties).

Breast Cancer in Ohio | 3

Female Breast Cancer Mortality by County
Figure 4. Average Annual Age-adjusted Mortality Rates of Female Breast Cancer per 100,000
by County of Residence, Ohio, 2015-2019

Lake
21.8 Ashtabula
Fulton Lucas 22.6
Williams 19.9
12.2 Ottawa
19.7 Geauga
22.3
Cuyahoga 20.5
Defiance Wood Sandusky Erie 23.3
Henry Lorain Trumbull
14.3 18.7 26.3 21.5
23.1 22.6 21.6
Portage
Seneca Huron
Paulding Medina Summit 20.1
16.5 17.2 18.6 Mahoning
19.3 Putnam Hancock 22.7
25.0 19.6 16.8
Van Wert Crawford Ashland
Wyandot 19.3 Wayne Stark Columbiana
19.1 14.3
Allen 17.5 Richland 23.0 23.6 20.2
22.8 Hardin 19.9
23.2 Marion Carroll
Auglaize 21.5 Holmes
Mercer Morrow 23.9 10.7
25.6 Jefferson
17.5 24.0 Knox
Logan 18.7 Tuscarawas 17.9
Shelby 22.7 Union Coshocton 22.3 Harrison
18.2 17.6 Delaware 18.6
16.3
19.6
Darke Champaign
Miami Licking Guernsey
19.7 22.2 Belmont
21.3 22.1 11.9
Franklin Muskingum 21.2
Clark Madison 22.2 18.1
26.7 30.3 Noble
Preble Montgomery Monroe
Fairfield Perry
30.1 22.4 Greene 23.2
Pickaway 17.7 Morgan
19.4 21.9
Fayette Hocking 24.2 Washington
Butler 25.8 21.3 23.8
20.3 Warren Clinton Ross Athens
22.3 25.9 22.2 Vinton 20.3
Hamilton Highland
22.8 Meigs
28.1 Pike 25.9
Clermont Rate per 100,000 Females
25.6 Jackson
20.6
15.3
Brown Scioto Gallia 10.7-18.6
14.9 Adams 23.5 15.0 18.7-21.3
18.6
Lawrence 21.4-23.1
28.8 23.2-30.3
N/A
Ohio Rate = 21.6
U.S. Rate = 19.9

Source: Bureau of Vital Statistics, Ohio Department of Health, 2022. N/A: Rate not calculated when the death count for 2015-2019 is less than 10.

In Ohio in 2015-2019, the county with the highest age-adjusted female breast cancer mortality rate (Madison County,
30.3 per 100,000) had a rate 2.8 times higher than the county with the lowest rate (Carroll County, 10.7 per 100,000).

Breast Cancer in Ohio | 4

Trends
Figure 5. Trends in Age-adjusted Incidence Rates of Female Breast Cancer per 100,000, Ohio, 1996-2019
160

140

120
Rate per 100,000 Females

100

80
— Black Female
60 — White Female
40

20

0
6 7 98 9 00 1 2 03 4 5 6 7 8 9 0 11 2 3 14 5 16 7 18 19
199 199 19 199 20 200 200 20 200 200 200 200 200 200 201 20 201 201 20 201 20 201 20 20
Source: Ohio Cancer Incidence Surveillance System, Ohio Department of Health, 2022.

Breast cancer incidence rates were relatively stable for both white women and Black women in Ohio from 1996 to 2019.

Figure 6. Trends in Age-adjusted Mortality Rates of Female Breast Cancer per 100,000, Ohio, 1996-2019

50
45
40
Rate per 100,000 Females

35
30
25
20
15
— Black Female
10
— White Female
5
0
6 7 98 9 00 1 2 03 4 5 6 7 8 9 0 11 2 3 14 5 16 7 18 19
199 199 19 199 20 200 200 20 200 200 200 200 200 200 201 20 201 201 20 201 20 201 20 20
Source: Bureau of Vital Statistics, Ohio Department of Health, 2022.

Breast cancer mortality rates decreased 37% from 1996 to 2019 for both Black women and white women in Ohio. For
each year, Black women had the highest breast cancer mortality rate.

Breast Cancer in Ohio | 5

Stage at Diagnosis
Cancer stage at diagnosis refers to the extent or spread of a cancer in the body and is an important determinant of
survival. If cancer cells are present only in the layer of cells (tissue) where they developed and have not spread, the
stage is in situ. If cancer cells have penetrated beyond the original layer of tissue, the cancer has become invasive and is
categorized as local, regional, or distant based on the extent of spread.

In situ and local stage cancers are known as “early stage” cancers, and regional and distant stage cancers are known as
“late stage” cancers. For example, in Ohio, approximately 72% of female breast cancers were diagnosed at an early stage
from 2015-2019.

Figure 7. Proportion of Female Breast Cancer Cases (%) by Stage at Diagnosis, Ohio, 2015-2019
Distant 5% Unstaged 2%

In Ohio from 2015-2019:

in situ 17% • 17% of breast cancer cases were in situ.

Regional 21% • 54% were diagnosed at a local stage.

• 21% were regional stage.

• 5% were distant stage.

Local 54%
• 2% were unstaged or had missing stage information
(Figure 7).

Source: Ohio Cancer Incidence Surveillance System, Ohio Department of Health, 2022.

Figure 8. Trends in Proportion of Female Breast Cancer Cases (%) by Stage at Diagnosis, Ohio, 1996-2019

80%
73.0%
70%
64.6%
60% —Early Stage
—Late Stage
50% — Unstaged/Unknown
40%

30% 28.8% 26.1%

20%

10% 6.6%
0.9%
0%
6 7 98 9 00 1 2 03 4 5 6 7 8 9 0 11 2 3 14 5 16 7 18 19
199 199 19 199 20 200 200 20 200 200 200 200 200 200 201 20 201 201 20 201 20 201 20 20
Source: Ohio Cancer Incidence Surveillance System, Ohio Department of Health, 2022.

The proportions of female breast cancer cases diagnosed at an early stage increased 13% from 1996 to 2019, while late-
stage diagnoses decreased slightly. The proportion of female breast cancer cases that were unstaged/unknown stage
decreased from 6.6% in 1996 to 0.9% in 2019.

Breast Cancer in Ohio | 6

Survival
In general, cancer survival is the estimated proportion of people alive at some point after cancer diagnosis, usually five
years. Five-year relative survival, the estimate used here, compares the survival of people diagnosed with cancer with
the survival of people in the general population who are the same age, race, and sex, and who have not been diagnosed
with cancer.

Figure 9: Five-Year Relative Survival (%) for Female Breast Cancer by Stage at Diagnosis, Ohio, 2012-2018

100% In Ohio, the five-year relative survival for breast cancer

100%
87% cases diagnosed from 2012 to 2018 was:
80% • 92% for all stages combined (not shown).
59% • Nearly 100% among those diagnosed at a local
60%
stage.
40%
31% • 87% at the regional stage.
20% • Only 31% when the cancer was diagnosed at the
latest (distant) stage.
0%
Local Regional Distant Unstaged/ • 59% for unstaged or unknown stage cases (Figure 9).
Unknown
Stage at Diagnosis
Source: Ohio Cancer Incidence Surveillance System, Ohio Department of Health, 2022.

Figure 10. Five-Year Relative Survival Trends for Female Breast Cancer, Ohio, 1996-2014

100% • Trends in five-year relative survival among women

83.0% 91.5%
90% diagnosed with breast cancer in Ohio increased from
80% 83.0% in 1996 to 91.5% in 2014 (Figure 10).
70%
60%
50%
40%
30%
20%
10%
0%
1996 2014

Source: Ohio Cancer Incidence Surveillance System, Ohio Department of Health, 2022.

Did You Know?

The Breast and Cervical Cancer Project offers no-cost breast and cervical
cancer screenings and diagnostic testing to qualified participants.
Call 1-844-430-BCCP for more information.

Breast Cancer in Ohio | 7

Female Breast Cancer by Anatomical Site
Figure 11. Proportion (%) of Female Breast Cancer Cases by Anatomical Site, Ohio, 2015-2019

Based on Ohio cancer data from 2015 to 2019:

• The highest percentage of cases occurred in the
upper-outer quadrant of the breast (35%).

• Overlapping lesion of the breast (a single tumor

which overlaps quadrants/sites) was the second most
common area (22%), followed by areas that were not
otherwise specified (13%) (data not shown).

• Other sites included cancers of the upper-inner

quadrant (12%), lower-outer quadrant (7%), lower-
inner quadrant (6%), central portion of the breast
(4%), axillary tail (0.5%), and nipple (0.3%).

Source: Ohio Cancer Incidence Surveillance System, Ohio Department of Health, 2022.
Image: https://commons.wikimedia.org/wiki/File:Breast_cancer_incidence_by_anatomical_site_(females).svg. (Adapted to show Ohio data.)

Female Breast Cancer by Histologic Type

Invasive Breast Cancer
Most (82.6%) female breast cancers in Ohio in 2015-2019 were invasive. Invasive cancer cells can spread, or metastasize,
to other parts of the body. The most common types of invasive breast cancer are:

• Invasive ductal carcinoma, also called infiltrating ductal carcinoma, begins in the lining of the milk ducts. This was
the most common type of invasive female breast cancer, accounting for an average of 7,472 cases, or 75.7% of all
invasive breast cancer cases in Ohio from 2015 to 2019.

• Invasive lobular carcinoma begins in the lobules (milk glands) of the breast. Lobular carcinoma, not otherwise
specified (NOS), represented an average of 1,010 cases, or 10.2% of all invasive breast cancer cases in Ohio from 2015
to 2019.

Mixed types of invasive ductal and lobular carcinoma made up 5.9% of invasive breast cancer cases in Ohio. There
are several other less common types of breast cancer such as mucinous adenocarcinoma (1.8% of cases), papillary
adenocarcinoma (0.5% of cases), Paget’s disease (0.2% of cases), and inflammatory breast cancer (0.2% of cases).

Non-invasive Breast Cancer

There was an average of 2,079 of non-invasive female breast cancer cases diagnosed each year in Ohio from 2015-2019.
Ductal carcinoma in situ (DCIS) is the most common type of non-invasive female breast cancer. DCIS is a breast disease
that may lead to invasive breast cancer. The cancer cells are only in the lining of the ducts and have not spread to other
tissues in the breast.

Breast Cancer in Ohio | 8

Female Breast Cancer Hormone Receptor Status and HER2 Status
Hormone Receptor Status
Hormone receptor status indicates whether breast cancer cells have receptors for estrogen or progesterone, which can
promote the growth of cancer. A cancer is called estrogen-receptor-positive (or ER+) if it has many estrogen receptors, or
estrogen-receptor negative (ER-) if it has few or no estrogen receptors. A cancer is progesterone-receptor-positive (PR+)
if it has many progesterone receptors, or progesterone-receptor negative (PR-) if it has few or no progesterone receptors.
Hormone receptor status is a main factor in planning breast cancer treatment. Hormone receptor-positive breast cancers
can be treated with hormone therapies, including tamoxifen and the aromatase inhibitors. Hormone receptor-negative
breast cancers are not treated with hormone therapies because they have few or no hormone receptors.

HER2 Status
HER2 (human epidermal growth factor receptor 2) is a protein that appears on the surface of some breast cancer cells.
HER2-positive (HER2+) breast cancers have a lot of HER2 protein, while HER2-negative (HER2-) breast cancers have little
or no HER2 protein. HER2 status is determined by testing tumor tissue and helps guide treatment. HER2+ breast cancers
can benefit from anti-HER2 drugs, such as trastuzumab (Herceptin), which directly target the HER2 receptor.

Combinations of Hormone Receptor Status and HER2 Status

Combinations of ER, PR, and HER2 status are important for deciding which treatments are most useful to women
diagnosed with breast cancer. Triple-negative breast tumors (ER-, PR-, HER2-) have little to no HER2 and few to no
estrogen or progesterone receptors. Younger women and Black or Hispanic/Latina women have a higher risk of being
diagnosed with triple-negative breast cancer. Triple-negative breast cancers grow and spread more quickly than most
other types of breast cancer. Because the cancer cells have few to no hormone receptors and little to no HER2, hormone
therapy and anti-HER2 drugs are not helpful in treating these cancers. Triple-positive breast tumors (ER+, PR+, HER2+)
are treated with hormone drugs as well as drugs that target HER2.

Figure 12. Proportion (%) of Invasive Female Breast Cancer Cases by Combinations of ER, PR,
and HER2 Status, Ohio, 2015-2019

- The most common type of female

ER+, PR+, HER2- 49.2%
63.1% breast cancer, based on hormone
-
ER-, PR-, HER2- (Triple Negative) 19.0% receptor/HER2 status, was ER+,
9.9% PR+, HER2-, which was more
-
ER+, PR-, HER2- 9.5% common among white women
7.7%
- Black
(63.1%) than Black women (49.2%)
7.4%
ER+, PR+, HER2+ (Triple Positive) in 2015-2019.
6.9% White
-
ER-, PR-, HER2+ 4.9%
3.7% This was followed by triple-
- negative breast cancer (ER-, PR-,
2.5%
ER+, PR-, HER2+ 2.4% HER2-), which was nearly twice
-
1.7% as common among Black women
ER-, PR+, HER2-
0.7%
- (19.0%) than white women (9.9%).
0.6%
ER-, PR+, HER2+ 0.4%
-
5.3%
Other* 5.2%
-
0% 20% 40% 60% 80%
Source: Ohio Cancer Incidence Surveillance System, Ohio Department of Health, 2022.
*One or more tests either not performed or unknown if performed, cannot be determined, not documented, or missing.

Breast Cancer in Ohio | 9

Female Breast Cancer Treatment
First course of treatment includes all methods of treatment recorded in the treatment plan and administered to
the patient before disease progression or recurrence. Treatment for breast cancer may involve one or more of the
following: breast-conserving surgery (surgical removal of the tumor and surrounding tissue), mastectomy (surgical
removal of the breast), removal of the lymph nodes under the arm, radiation therapy, chemotherapy, hormone therapy,
immunotherapy, or other therapy. Numerous studies have shown that, for early-stage disease, long-term survival after
breast-conserving surgery plus radiation therapy is similar to mastectomy.

Figure 13. Proportions of First Course of Treatment for Invasive Female Breast Cancer, Ohio, 2015-2019

Immunotherapy
5% Surgery was the major part (38%) of first course of
treatment for invasive breast cancer in Ohio during
2015 to 2019, followed by hormone therapy (27%),
chemotherapy (16%), radiation (14%), immunotherapy
Radiation
14% (5%), and other therapy (0.2%, data not shown).

Surgery 38% Data are based on initiated first course of treatment

Chemotherapy only. Treatments planned but not yet started at the
16%
time of reporting to OCISS are not included. Although
Hormone cancer cases must be reported to OCISS within six
Therapy 27% months of diagnosis or treatment, first course of
treatment may not be complete at the time of
reporting.

Source: Ohio Cancer Incidence Surveillance System, Ohio Department of Health, 2022.

Figure 14. Trends in Selected Types of Surgery During First Course of Treatment for Invasive Female Breast
Cancer as a Proportion (%) of Total Surgeries, Ohio, 2000-2019

50%
45%
40%
35% Lumpectomy
Percent of Total Surgeries

30% Single Mastectomy

25% Double Mastectomy
Modified Radical Mastectomy
20%
15%
10%
5%
0%
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019
Year of Diagnosis
Source: Ohio Cancer Incidence Surveillance System, Ohio Department of Health, 2022.

Modified radical mastectomies decreased dramatically in Ohio from 2000 to 2019 and were largely replaced by
lumpectomies (also known as breast-conserving surgery), which increased during this time. Both single mastectomies
and double mastectomies (contralateral prophylactic mastectomies) increased from 2000 to 2014 but remained
relatively stable during 2015 to 2019.

Breast Cancer in Ohio | 10

Risk Factors
Anything that increases the chance of getting a disease is called a risk factor. Having one or more risk factors does not
mean that a person will develop the disease. Below are some of the risk factors for female breast cancer.

Potentially Modifiable Risk Factors

Having children after 30 or not having children: Women who have had no children or who had their first child after
age 30 have a slightly higher breast cancer risk.

Oral contraceptive use: Women who currently or recently used oral contraceptives have a slightly increased risk
compared with women who stopped using them more than 10 years ago or never used them.

Use of menopausal hormone therapy: Women who use combined estrogen and progesterone menopausal hormone
therapy for two or more years are at increased risk. This increased risk goes away within five years of nonuse.

Not breastfeeding: Women who have never nursed have a slightly increased risk, compared with women who have
nursed.

Overweight and obesity: Women who are overweight or obese after menopause have an increased risk of breast cancer.

Not being physically active: Women who are not physically active have a higher risk, compared with women who are.

Alcohol: The more alcohol a woman drinks, the greater her risk of breast cancer.

Previous breast/chest radiation: Women who had radiation therapy to the chest area before age 40 as treatment for
another cancer or other medical conditions have increased risk.

Non-Modifiable Risk Factors

Age: Risk of developing breast cancer increases with age. Most breast cancers are diagnosed in women age 55 and older.

Sex: Breast cancer is about 100 times more common among women than men.

Race and ethnicity: Nationally, white women are slightly more likely to develop breast cancer than Black women.
However, Black women are more likely to die from breast cancer. Asian, Hispanic, and Native American women have a
lower risk of developing and dying from breast cancer.

Genetic alterations: About 5-10% of cases are hereditary and result from gene mutations, most commonly mutations
of the BRCA1 and BRCA2 genes. Ashkenazi Jewish are at increased risk due to increased prevalence of BRCA1 and BRCA2
mutations.

High breast tissue density: Women with high breast tissue density (the amount of glandular tissue relative to fatty
tissue measured on a mammogram) have higher risk of breast cancer.

Family history: Risk is higher if a first-degree relative has had breast cancer, especially if the family member was
diagnosed before age 50.

Personal history: Women who have had breast cancer have an increased risk of developing a new breast cancer (either
in the other breast or a different part of the same breast). In addition, women with DCIS, lobular carcinoma in situ
(LCIS), or proliferative lesions with or without cell abnormalities (e.g., hyperplasia) are at increased risk.

Long menstrual history: Women who started menstruating before age 12 or who went through menopause after age 55
have a higher risk.

Diethylstilbestrol (DES): Women who were given DES during pregnancy and women whose mother took DES while
pregnant have slightly increased risk.

Breast Cancer in Ohio | 11

Signs and Symptoms of Breast Cancer
• Lump or swelling in the breast or underarm area.
• Persistent changes in the breast such as skin irritation, dimpling, thickening, swelling, distortion, or tenderness.
• Nipple ulceration or retraction (turning inward).
• Redness or scaliness of the nipple or breast skin.
• Nipple discharge (other than breast milk).
• Pain in any part of the breast including the nipple.

Any of these symptoms may be caused by cancer or by other, less serious health problems. If you have any of these
symptoms, see your healthcare provider.

Early Detection
Regular mammograms can help find breast cancer early. The U.S. Preventive Services Task Force (USPSTF) recommends
mammography screening every two years for women ages 50-74 who are at average risk. Women with a parent, sibling,
or child with breast cancer are at higher risk for breast cancer and may benefit from beginning screening in their 40s.

Table 2. Prevalence of Women Ages 50-74 Years Who Reported Having Had a Mammogram in
the Past Two Years by Demographics, Ohio, 2020

Demographics Prevalence
95% CI
(%)
Total 78.3 76.3 - 80.3
Age
Among Ohio women ages 50-74 years, the prevalence of
50 - 54 70.2 65.1 - 75.3
mammography in the past two years was:
55 - 64 79.1 76.0 - 82.1
• 78.3% overall.
65 - 74 81.5 78.8 - 84.3
Race/Ethnicity • Significantly higher among women ages 55-64 and
White, Non-Hispanic 78.4 76.3 - 80.4 65-74 years, compared with women ages 50-54
Black, Non-Hispanic 85.0 79.4 - 90.6 years.
Hispanic N/A N/A - N/A • Not significantly different between white, non-
Other, Non-Hispanic N/A N/A - N/A Hispanic women and Black, non-Hispanic women.
Multi-Racial N/A N/A - N/A • Significantly higher among Ohio women in the
Annual Household Income highest income category ($75,000+), compared with
<$15,000 68.9 61.6 - 76.1 those earning less than $50,000 per year.
$15,000 - $24,999 73.7 68.2 - 79.1 • Significantly higher among college graduates,
$25,000 - $34,999 67.5 59.3 - 75.8 compared with those with a high school diploma or
$35,000 - $49,999 75.5 69.6 - 81.5 less education.
$50,000 - $74,999 79.3 74.1 - 84.4
$75,000+ 86.0 82.9 - 89.2
Education
Less than High School 70.2 61.5 - 79.0
High School Diploma 75.0 71.4 - 78.5
Some College 78.9 75.4 - 82.5
College Graduate 84.0 81.1 - 87.0
Source: 2020 Ohio Behavioral Risk Factor Surveillance System, Ohio Department of Health, 2022.
N/A = Not Applicable; estimate does not meet the reliability criteria for reporting set by the CDC.
95% CI = 95% Confidence Interval.

Breast Cancer in Ohio | 12

Genetic Counseling
Women who have inherited changes (mutations) to certain genes, such as BRCA1 and BRCA2 (BRCA is an abbreviation
for BReast CAncer gene) are at higher risk of breast cancer. Not every woman who has a BRCA1 or BRCA2 gene mutation
will get breast cancer. According to the Centers for Disease Control and Prevention (CDC), about 50 out of 100 women
with a BRCA1 or BRCA2 gene mutation will get breast cancer by the time they turn 70 years old, compared with only 7
out of 100 women in the general U.S. population. For more information, see Video: BRCA Genes and Breast Cancer.

Genetic counseling related to breast cancer is appropriate for anyone with a personal history or a first- or second-
degree relative with the following:

• Breast cancer at or younger than age 50.

• Triple negative breast cancer at any age.
• Breast cancer, bilateral or multiple tumors.
• Breast cancer that is recurrent or metastatic and HER2/neu negative.
• Breast cancer at any age and Ashkenazi Jewish ancestry.
• Male breast cancer.

Additional information can be found in Criteria For Referral for Cancer Genetics Evaluation: https://odh.ohio.gov/know-
our-programs/genetic-services/materials-publications/criteria-for-referral-cancer-genetics-eval.

The Ohio Department of Health (ODH) Genetics Services Program funds a network of genetic centers that provide
comprehensive care and services to people affected with or at risk for genetic disorders. Genetic services include genetic
counseling, education, diagnosis, and treatment for genetic conditions and congenital abnormalities. There are currently
24 counties in Ohio where Ohio Cancer Genetics Risk Assessment sites are located. Site names, addresses, and contact
information can be found at https://odh.ohio.gov/know-our-programs/genetic-services/Ohio-Cancer-Genetics-Risk-
Assessment-Sites.

Breast Cancer in Ohio | 13

Technical Notes
Age-Adjusted Rate: A summary rate that is a weighted average of age-specific rates, where the weights represent
the age distribution of a standard population (direct adjustment). The incidence and mortality rates presented in this
report were standardized to the age distribution of the 2000 U.S. Standard Population. Under the direct method,
the population was first divided into 19 age groups, i.e., <1, 1-4, 5-9, 10-14, 15-19 ... 85+, and the age-specific rate was
calculated for each age group. Each age-specific rate was then multiplied by the standard population proportion for the
respective age group.

Average Annual Number: The number of cases or deaths diagnosed per year, on average, for the time period of interest
(e.g., 2015 to 2019). Average annual numbers are calculated by summing the number of cases or deaths for a given time
period, dividing by the number of years that comprise the time period, and rounding to the nearest whole number.

Confidence Interval (CI): An estimated range of values for a measure constructed so the range has a specified
probability of including the true value of the measure in the population.

Incidence: The number of cases diagnosed during a specified time period (e.g., 2015 to 2019). Breast cancer cases
were defined by the International Classification of Diseases for Oncology, Third Edition (ICD-O-3), and categorized
by C500-C509, excluding 9050-9055, 9140, 9590-9992, in accordance with the SEER Program of the National Cancer
Institute.

Invasive Cancer: A malignant tumor that has infiltrated the organ in which the tumor originated. Invasive cancers
consist of those diagnosed at the local, regional, distant, and unstaged/missing stages. Only invasive cancers were
included in the calculation of incidence rates in this document.

Histology: The study of tissues and cells under a microscope.

Mortality: The number of deaths during a specified time period (e.g., 2015 to 2019). Breast cancer deaths were
defined by the International Statistical Classification of Diseases and Related Health Problems, Tenth Edition (ICD-10),
C500-C509.

Population Data Used to Calculate Rates: The 1996 to 2019 rates were calculated using population estimates from
the U.S. Census Bureau and National Center for Health Statistics. Population data were compiled from bridged-race
intercensal population estimates for July 1, 1990 to July 1, 1999 (released July 26, 2004); revised bridged-race intercensal
population estimates for July 1, 2000 to July 1, 2004 (released Oct. 26, 2012); revised bridged-race intercensal population
estimates for July 1, 2005 to July 1, 2009 (released June 26, 2014), and vintage 2020 bridged-race postcensal population
estimates for July 1, 2010 to July 1, 2020 (released September 22, 2021).

Prevalence: The proportion of people with a certain disease or characteristic at a given time.

Rate: The number of cases or deaths per unit of population (e.g., per 100,000 persons) during a specified time period
(e.g., 2015 to 2019). Rates may be unstable and are not presented when the count is less than five.

Relative Survival: The percentage of people who are alive at a designated time period (usually five years) after a cancer
diagnosis divided by the percentage expected to be alive in the absence of cancer based on normal life expectancy.
Stage at Diagnosis: The degree to which a tumor has spread from its site of origin at the time of diagnosis. A system of
summary staging is often used to group cases into the following stages:

In situ — Noninvasive cancer that has not penetrated surrounding tissue.

Local — A malignant tumor confined entirely to the organ of origin.

Regional — A malignant tumor that has extended beyond the organ of origin directly into surrounding organs or
tissues or into regional lymph nodes.

Distant — A malignant tumor that has spread to parts of the body (distant organs, tissues, and/or lymph nodes)
remote from the primary tumor.

Unstaged/Unknown Stage — Insufficient information is available to determine the stage or extent of the disease at
diagnosis.

Breast Cancer in Ohio | 14

Table 3. Average Annual Number and Age-adjusted Rates of Invasive Female Breast Cancer Cases and
Deaths per 100,000 Females by County of Residence, Ohio and the United States, 2015-2019

Incidence Mortality Incidence Mortality Incidence Mortality

Cases Rate Deaths Rate Cases Rate Deaths Rate Cases Rate Deaths Rate
Ohio 9,871 130.6 1,743 21.6 Greene 148 137.3 22 19.4 Morrow 27 116.6 6 24.0
U.S. 128.3 19.9 Guernsey 24 93.5 3 11.9 Muskingum 79 139.1 11 18.1
Adams 19 102.8 4 18.6 Hamilton 692 138.0 121 22.8 Noble 9 112.0 1 N/A
Allen 80 120.6 15 22.8 Hancock 60 124.1 11 19.6 Ottawa 45 132.9 8 22.3
Ashland 44 117.4 8 19.3 Hardin 23 122.7 4 23.2 Paulding 12 99.5 3 19.3
Ashtabula 81 121.3 17 22.6 Harrison 15 133.1 2 18.6 Perry 29 129.0 4 17.7
Athens 34 104.3 7 20.3 Henry 21 120.4 5 23.1 Pickaway 39 110.0 7 21.9
Auglaize 35 120.1 8 25.6 Highland 32 114.8 8 28.1 Pike 24 136.0 5 25.6
Belmont 60 123.5 11 21.2 Hocking 23 115.2 4 21.3 Portage 129 126.8 21 20.1
Brown 29 99.3 5 14.9 Holmes 19 83.3 6 23.9 Preble 37 124.9 9 30.1
Butler 305 135.1 47 20.3 Huron 50 135.6 7 17.2 Putnam 30 134.0 6 25.0
Carroll 25 121.7 3 10.7 Jackson 25 114.7 4 15.3 Richland 95 119.1 18 19.9
Champaign 31 116.8 6 22.2 Jefferson 59 118.8 9 17.9 Ross 59 117.6 11 22.2
Clark 138 146.7 26 26.7 Knox 47 118.3 9 18.7 Sandusky 60 145.1 12 26.3
Clermont 176 132.7 27 20.6 Lake 232 139.9 39 21.8 Scioto 57 110.8 13 23.5
Clinton 35 129.1 8 25.9 Lawrence 56 133.7 12 28.8 Seneca 50 141.2 7 16.5
Columbiana 91 124.1 16 20.2 Licking 167 147.8 26 22.1 Shelby 35 115.4 6 18.2
Coshocton 27 102.8 5 16.3 Logan 33 114.2 7 22.7 Stark 330 125.2 66 23.6
Crawford 30 96.9 5 14.3 Lorain 273 134.7 50 22.6 Summit 497 136.1 89 22.7
Cuyahoga 1,171 135.8 222 23.3 Lucas 338 122.7 58 19.9 Trumbull 179 118.5 35 21.6
Darke 40 110.6 8 19.7 Madison 33 123.2 8 30.3 Tuscarawas 74 115.0 17 22.3
Defiance 28 107.2 4 14.3 Mahoning 209 122.9 35 16.8 Union 35 110.4 5 17.6
Delaware 165 141.5 22 19.6 Marion 54 130.8 9 21.5 Van Wert 18 94.3 5 19.1
Erie 66 115.3 13 21.5 Medina 160 134.6 24 18.6 Vinton 10 107.7 2 N/A
Fairfield 123 127.7 23 23.2 Meigs 17 108.8 4 25.9 Warren 192 137.7 31 22.3
Fayette 26 137.0 5 25.8 Mercer 31 114.5 5 17.5 Washington 59 132.4 11 23.8
Franklin 941 136.7 156 22.2 Miami 98 137.8 16 21.3 Wayne 94 127.8 18 23.0
Fulton 32 116.9 3 12.2 Monroe 11 108.7 1 N/A Williams 32 117.1 6 19.7
Gallia 21 97.1 3 15.0 Montgomery 517 144.3 87 22.4 Wood 94 125.1 15 18.7
Geauga 97 144.0 16 20.5 Morgan 13 134.3 3 24.2 Wyandot 14 87.3 3 17.5
Source: Ohio Cancer Incidence Surveillance System and Bureau of Vital Statistics, Ohio Department of Health, 2022; Surveillance, Epidemiology, and End Results
Program, National Cancer Institute, 2022.

Breast Cancer in Ohio | 15

Sources of Data and Additional Information
Ohio Department of Health:
Ohio Cancer Incidence Surveillance System (OCISS)
Comprehensive Cancer Control Program
Breast & Cervical Cancer Project | Ohio Department of Health

Ohio Public Health Data Warehouse:

https://publicapps.odh.ohio.gov/EDW/DataCatalog

National Cancer Institute:

https://www.cancer.gov/types/breast

American Cancer Society:

https://www.cancer.org/cancer/breast-cancer.html

U.S. Cancer Statistics:

www.cdc.gov/cancer/dataviz

To address comments and information requests:

Ohio Cancer Incidence Surveillance System (OCISS)

Ohio Department of Health
246 North High Street
Columbus, OH 43215
Phone: (614) 752-2689
Email: [email protected]

Acknowledgements

Ohio Department of Health

Holly L. Sobotka, MS; John Kollman, MS; Justina Sleesman, MPH

Sincere appreciation to the OCISS, cancer registrars, medical records technicians, and other health professionals who
improve the collection and quality of cancer data in Ohio.

Suggested Citation

Breast Cancer in Ohio 2022. Ohio Cancer Incidence Surveillance System, Ohio Department of Health, October 2022.

This report is public information. Reproduction and copying of this report for cancer prevention and control, education,
and program planning are highly encouraged. Citation of source, however, is appreciated.

OCISS is partially supported by the National Program of Cancer Registries (NPCR) at the Centers for Disease Control and
Prevention (CDC) through Cooperative Agreement Number NU58DP006284. The contents are the sole responsibility of
the authors and do not necessarily represent the official views of the CDC.

Breast Cancer in Ohio | 16