Black women should be screened for breast cancer earlier: study

Women’s Health

By Brooke Kato

April 20, 2023 | 8:02pm

Black women should be screened for breast cancer eight years earlier than guidelines recommend, new research suggests.

Published in the JAMA Network Open journal on Wednesday, the study explored whether 50 was actually the best time to start undergoing mammograms.

The international team of researchers found black women are at a disproportionately higher risk of dying from breast cancer, so they are advising this demographic start breast cancer screening at 42.

“The current one-size-fits-all policy to screen the entire female population from a certain age may be neither fair and equitable nor optimal,” the study authors wrote.

The current guidance, set forth by the US Preventive Services Task Force, is based on the risk of developing breast cancer, which is the second leading cause of cancer death in American women.

Women 40 to 49 are encouraged to discuss their options with their physician and develop an individualized plan.

Breast cancer is the most commonly diagnosed cancer
among black women, with the American Cancer Society predicting 36,260 new cases in 2022.

Black women have the highest rate of breast cancer mortality and have nearly a three-fold increased risk of being diagnosed with an invasive and fast-growing type of cancer called triple-negative breast cancer.

The new study analyzed data from more than 415,000 American women who died of breast cancer from 2011 to 2020, grouping patients by race and ethnicity.

Researchers discovered that for every 100,000 black women in their 40s, there were 27 deaths. In the same number of white women in their 40s, there were 15 deaths.

They advised black women be screened at 42, while the same risk for white women doesn’t come until 51. American Indian, Alaska native and Hispanic women could be screened at 57, while Asian and Pacific Islander women could hold off until 61.

“This may be an important step toward a more optimized, equitable, and personalized [breast cancer] screening and may help mitigate the current long-standing disparity of early-onset [breast cancer] mortality in populations, especially black females, at increased risk,” the study authors wrote.

Experts believe implicit bias in the medical industry prevents black women from receiving adequate care compared to their white counterparts.

“There are systemic issues, access to care issues that really go beyond biology,” Dr. Arif Kamal, the chief patient officer for the American Cancer Society, told CNN.

“The reality is cancer affects everybody and it does not discriminate. Where the discrimination sometimes occurs is after the diagnosis, and that’s really what we need to focus on.”

Dr. Rachel Freedman, a breast oncologist at the Dana-Farber Cancer Institute who was not involved in the study, told the outlet that while current guidelines do account for cancer risk, “race and ethnicity have not been traditional factors that go into these decisions.”

“This study confirms that the age of breast cancer-mortality is younger for black women, but it doesn’t confirm why and if screening is even the main reason,” she added, pointing to the lack of access to the patients’ screening history.

“We have no information about the types of cancers women developed and what treatment they had either, both of which impact mortality from breast cancer.”

While screening can catch breast cancer earlier — saving lives — the Centers for Disease Control and Prevention also warns of the risks, which include over-diagnosis, over-treatment and radiation exposure.

The agency named false positives as a potential harm, which not only cause patient stress, but also result in further tests that can be invasive and costly.

“While some may argue that earlier screening may lead to increased recalls and unnecessary biopsies, women get recalled for additional imaging about 10% of the time and biopsies are needed in 1-2% of cases, which is quite low,” Dr. Kathie-Ann Joseph, a surgical oncologist at the Perlmutter Cancer Center at NYU Langone, told CNN.

“This has to be compared to the lives saved from earlier screening mammography,” continued the surgery and population health professor. “I would also like to point out that while we certainly want to prevent deaths, earlier screening can have other benefits by allowing women of all racial and ethnic groups to have less extensive surgery and less chemotherapy which impacts quality of life.”