Breast cancer is the second most common cancer in women and the second leading cause of cancer death in the United States. Although breast cancer is slightly less common in black than in white women in the US, black women are more likely to die from the disease.
The U.S. Preventive Services Task Force (USPSTF) — a group of independent medical experts who make recommendations on clinical preventive services, such as screening tests — recommends that women begin breast cancer screening at age 50. However, the group notes that women have a choice to get mammograms earlier, starting at age 40.
Now, researchers involved in a large new study suggest that health policymakers and clinicians consider screening black women for breast cancer earlier than other racial and ethnic groups, starting at age 42. This strategy, the researchers said, could narrow the breast cancer mortality gap that exists between black women and white women.
“The current one-size-fits-all policy of screening the entire female population over a certain age may not be fair and equitable, nor optimal,” the researchers wrote in the study, published last week in the journal JAMA Network Open. was published.
While black women are diagnosed with breast cancer at the same rate as other ethnicities, they have dramatically higher mortality rates. Compared to white women, black women have a 4% lower incidence of breast cancer but a 40% higher risk of dying from the disease.
The significant difference in breast cancer mortality between the two groups has remained stable since 2011, after increasing in the past three decades, the researchers said.
The study looked at a total of 415,277 female breast cancer deaths in the US from 2011 to 2020. The data set included age, race and ethnicity categories.
The researchers then estimated the 10-year cumulative risk of dying from breast cancer in the general population after reaching age 50 — the time the USPSTF recommends that women begin having biannual mammograms. Based on the data, the study authors concluded that black women reach this level of risk at age 42, about eight years earlier than white women, and they suggest that it would make sense to screen them earlier.
“The take-home message for US clinicians and health policymakers is a simple one. Clinicians and radiologists should consider race and ethnicity when determining the age at which breast cancer screening should begin,” Dr. Mahdi Fallah, one of the study’s authors and leader of the Risk-Adapted Cancer Prevention Group at the German Cancer Research Center in Heidelberg. , Germany, told CNN.
Robert A. Smith, senior vice president of cancer screening at the American Cancer Society, said the study was “well done” and he expects it to generate “considerable debate about enduring differences in the risk of death from breast cancer between black and white women.”
“This study suggests that our current recommendations for mammographic screening in the US (and the age at which women begin this screening) should not be uniform and should instead be based on an individual’s risk of breast cancer,” Dr. Rachel Freedman, a breast cancer oncologist at the Dana-Farber Cancer Institute, told Yahoo News in an email.
She noted that current breast cancer screening guidelines already recommend that the time a woman initiates routine mammograms is based on her risk of developing cancer. However, race and ethnicity are not traditional factors considered in these decisions, and perhaps they should be.
Smith said that, as the study authors noted, cancer screening guidelines have historically been based on risk in the general population, even though certain groups have different levels of risk.
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“There are increasing calls for recommendations to be tailored not only to group differences, but also to individual differences, as individuals in groups may have similar differences in the risks we see across groups,” Smith said in an email.
But both Smith and Freedman noted that many medical groups’ breast cancer screening recommendations already differ somewhat from the USPSTF guidelines referenced in the study.
“The American Cancer Society (ACS) recommends that all women begin screening at age 45,” Smith said, adding that women should also have the option to begin screening earlier. Most women, he explained, don’t wait until they’re 50 to get their first mammogram and instead start screening in their early 40s.
Smith also said his organization is in the process of updating breast cancer screening guidelines.
“We are examining the scientific literature to see how screening guidelines might differ for women across different racial and ethnic groups, and by other risk factors, in a way that would reduce differences based on risk and differences in outcome,” he said.
While earlier screening may be beneficial for women of all ethnicities, some experts doubt that earlier screening for Black Americans will have a dramatic impact on current differences in mortality rates because these differences, they say, are more strongly correlated with things like socioeconomic differences and disparities in access to healthcare, which previous screening recommendations cannot answer.
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Biological factors also contribute to the disparity in breast cancer death rates between black and white women, experts say. According to the Breast Cancer Research Foundation, “Black women are disproportionately affected by more aggressive subtypes, such as triple-negative breast cancer (TNBC) and inflammatory breast cancer.” They are also more likely to be diagnosed at a younger age and when the disease is at an advanced stage.
Freedman said early screening may have some impact on narrowing the breast cancer mortality gap because cancer can be detected earlier, but there are multiple factors that affect a woman’s long-term outcome with breast cancer. Some of these include “tumor characteristics, tumor biology, treatments received, barriers to care, lack of access to quality care and disproportionate levels of poverty among black women compared to white women,” she said.
“Screening is an important part, but certainly not the only part,” explains Freedman. “In some places where screening rates are high for race and ethnicity, you’re still going to see disparities in mortality.”
While Freedman thinks the study’s findings are intriguing and should be followed up with further studies, they are not enough to change current screening practices, she told Yahoo News.
The researchers who conducted the study recognized that multiple factors, including those highlighted by Freedman, contribute to the disparity in breast cancer death rates between black women and women of other ethnicities. But while these issues are complex, the authors envision this early testing strategy as an easy step that could potentially make a difference.
“Overcomplicating everything can lead to doing nothing,” the researchers said. “One can try to start with a first scientific step (such as screening adapted to race and ethnicity) and evaluate and build and re-evaluate more complex steps along the way. Otherwise, the racial and ethnic disparities of early BC [breast cancer] mortality may persist or even increase again.”
