Official Black Health Matters Breast Cancer Screening Guide

Breast cancer affects black adults in more ways than many other populations. This means that cancer screenings and prevention are crucial to flipping the statistics. Many women don’t realize they have cancer until their doctor detects a breast lump at a routine appointment or it’s time for regular mammograms. With the Official Black Health Matters Breast Cancer Screening Checklist, we can help prevent or improve the odds of survival among black women.

Keep reading for more about how cancer affects black adults, breast cancer screening methods, recommended screenings by age, and how to reduce your risk.

The Importance of Early Detection

Most breast cancers are easily treated when caught early, so you must perform breast self-exams regularly and discuss your risk factors with a knowledgeable provider. There are many types of breast cancers, including invasive ductal carcinoma, inflammatory breast cancer, and Paget disease. Black Americans are much more likely to be affected by aggressive forms of cancer, and death rates are higher. Understanding cancer and knowing your body are key to detecting the changes that indicate any disease.

Breast Cancer in Black Women

Like most health concerns affecting African Americans, breast cancer disproportionately affects the black population. There are many reasons, including the healthcare system, social and economic problems, and even race biology.

Healthcare Disparities

Black people experience healthcare differently in the US, and this is a complex problem. According to Pew Research, nearly half of the people interviewed said that providers and facilities often provided a lower level of care. A similar number reported that they were less likely to receive advanced care. There are even more reasons why these are true, like the disproportionate number of black providers in the healthcare system and an undertone of racial bias.

Social and Economic Issues

There is a long history of Black Americans being affected by social and economic concerns. Breast cancer screening is another way in which the disparities are pretty evident. Without access to quality medical care, medical breast cancer screening or diagnostic testing may not be available. This is especially true in low-income areas with very little patient education.

Some ethnic groups are more likely to develop breast cancer because they are also more likely to have pre-existing conditions, like being overweight, drinking alcohol, smoking, or having diabetes or high blood pressure. These are all more common within the African American population.

Biological Factors

Black Americans are more susceptible to aggressive forms like triple-negative breast cancer, or TNBC. It seems many black women are also diagnosed very young, especially compared to other races or multiracial people. Even if caught early, many of these cancers have limited treatment options, which has affected death rates. These findings highlight the need for more research and understanding of why other groups are not affected similarly.

Types of Breast Cancer Screening

The Monthly Self Breast Exam (BSE)

The CDC, American Cancer Society, and non-profit organizations like the Breast Cancer Research Foundation agree that regular self breast exams are vital for early detection. By performing them consistently and at roughly the same time each month, you’ll get to know their texture and overall feel. Then, it’s easier to sense if something feels off. You should always follow the suggested guidelines for BSEs, so you are more likely to feel a breast lump. Additional changes that you should look for include:

• Swelling: This may affect only one breast or one area of a breast. It may even be located under the armpit near the lymph nodes.
• Skin Irritation: A rash or redness may be a reaction to new laundry detergent, but your physician should evaluate any signs of persistent skin irritation.
• Nipple Discharge: Not all breast cancer occurs with a lump. The only noticeable sign may be abnormal nipple discharge like ductal carcinoma.
• Dimpling: If one area of the skin around your breast begins to look like an orange peel, it could be a sign of inflammatory breast cancer, or IBC.
• Nipple Changes: Some changes are common and expected, like during pregnancy or breastfeeding. However, you should discuss any unexpected ones immediately, like redness or pain, flaking, or turning inward.

All About Mammograms

Mammograms get a bad rap as being painful. Although you’ll likely still feel pressure, you shouldn’t be uncomfortable. These tests take x-rays of your breasts with a special machine designed to compress breast tissue enough that any abnormalities can easily be seen.

2D vs. 3D Mammograms

Many older women, especially African Americans in lower-income neighborhoods, are familiar with 2D mammograms that appear as traditional x-ray images. However, 3D mammograms produce a 3-dimensional view of the breast through multiple digital 2D images. Either mammogram offers breast cancer screening vital to early detection, but 3D mammograms may be able to detect other types of cancer, especially in black people with more risk factors.

Screening vs. Diagnostic Mammogram

A diagnostic mammogram is performed the same way as one for screening purposes but requires many more pictures to ensure the radiologist has a better view of the area in question. A 3D mammogram may be ordered for diagnostic reasons.

Genetic Testing

BRCA-1 and BRCA-2 are DNA gene mutations that increase a person’s chances of developing breast cancer at some point in their lives. While other genes could also indicate an increased risk, these are the two most common and well-known. Not everyone should get genetic testing for breast cancer, mainly because testing positive for the gene does not prove you will get it. Genetic testing should be considered along with many other risk factors, like ethnic background and family history, to determine the likelihood of breast cancer.

Other Screening Methods

Monthly BSEs and mammograms are routine and should become part of your life once you reach the right age or your doctor has recommended them. However, there are many other ways in which your provider may screen for breast cancer, especially if you’ve detected a lump.

• Clinical Breast Exam: These are performed by your provider, typically at your well-woman check-up. How often you need them is mainly determined by your age.
• Breast Ultrasound: An ultrasound is typically performed after a lump is felt. In most cases, it can rule out a lump as a cyst or dense fatty tissue instead of a mass fairly quickly.
• Breast MRI: If other tests have not definitively ruled out any chance of breast cancer, an MRI is usually the next step. They are much more detailed and accurate.
• Thermography: This type of testing produces results similar to an infrared camera. Any areas with an inflammatory response in the breast tissue show up brighter. You’ll likely need a traditional mammogram if anything shows abnormal with thermography.
• Tissue Biopsy: If a lump or mass is detected and any of the above diagnostic tests have not ruled out cancer, your provider will order a biopsy to be tested at a lab.

Screening Suggestions by Age

Your age will primarily determine the type of screening recommended. The list below provides recommendations for most healthy adults. However, your provider may suggest some screenings earlier, like starting yearly mammograms in your 30s, due to risk factors or because you’ve received another diagnosis closely related to breast cancer.

• Monthly self-breast exams starting at age 20
• Lifestyle counseling and screening for related cancers (thyroid, ovarian, etc.) starting at age 30
• Annual clinical breast exams and mammograms starting at age 40

Lowering Your Risk for Breast Cancer

In addition to BSEs and mammograms, the American Cancer Society recommends many ways to lower your risk of developing breast cancer. Remember, lifestyle changes may be challenging but could prevent many other diseases. Others include high blood pressure and diabetes, also risk factors for breast cancer.

• Lose Weight (or Maintain a Healthy Weight)
• Exercise Regularly
• Avoid (or Limit) Alcohol Intake

The most common type of breast cancer is ductal carcinoma which forms in the milk ducts. It can be either non-invasive and stay within the breast tissue or an invasive ductal carcinoma and spread. Women who can and wish to may also want to consider having a baby. This has been shown to significantly impact the risk of this type of breast cancer, as has breastfeeding for at least six months.

Hormonal treatments for menopause symptoms may increase your risk. You should discuss non-hormonal or other treatment options with your provider if you have concerns.

For Those at High Risk

Prevention and early detection are even more crucial if you are at higher risk. Thankfully, there are ways you can stay one step ahead. Genetic testing is becoming more common and may even be covered by some insurance plans. Your provider may suggest taking medications if you test positive for cancer-causing genes.

While a more drastic approach, your provider may also discuss preventative surgery. This will largely depend on family history and genetic testing to determine the most likely type of breast cancer you would develop. Race, a prior diagnosis, and other factors could also play a role, but surgery comes with its own risks and should be considered carefully.

Putting It All Together

Screening for breast cancer improves the chances of catching it early and having the most treatment options. Because African Americans are at higher risk of developing a more aggressive type, noticing a breast lump or other changes in your body is essential. Follow the screening checklist above and always follow up with your provider if you have any concerns. Black Health Matters aims to address the impact of breast cancer risk among black people by supporting research and awareness.