New Study Shows Black Women Should Begin Breast Cancer Screening Earlier

All women are recommended to begin regular breast cancer screenings at age 50 but new research shows a one-size-fits-all approach may not benefit everyone—and that Black women in particular should begin screenings eight years earlier, around age 42.

The suggestion comes from a new study, published in April in the journal JAMA Network Open, which sought to examine the disparities in breast cancer mortality by race, and provide suggestions on new race- and ethnicity-adapted starting ages for breast cancer screenings.

“We have a lot of guidelines to help us determine when people should get screened for breast cancer, but we haven’t historically really factored race in, or weighed race or ethnicity as strongly into those guidelines,” Toma Omofoye, MD, associate professor of radiology at the University of Texas MD Anderson Cancer Center, told Health. “However, race and ethnicity do have [a] significant impact on breast cancer outcomes.”
The disparities in breast cancer mortality rates between Black and White women are glaring: Despite similar incidence rates, Black women are 40% more likely to die from the disease. And in Black women under 50, breast cancer death rates are double those of white women.

Insufficient data, however, has hindered any potential recommendations on race-adjusted screening recommendations—and even this new research doesn’t make any clinical recommendations, but rather offers suggestions on how to make breast cancer screenings more equitable and personalized, and how to mitigate the disparities in breast cancer mortality.

Here’s what to know about why Black women may benefit from an earlier starting date for breast cancer screenings, how race and ethnicity affect a person’s cancer risk, and how to determine the best time to begin screening for breast cancer.

Evaluating When to Start Screening for Breast Cancer

Current guidelines for starting mammography come from the U.S. Preventive Services Task Force (USPSTF). The group recommends that all women age 50 to 74 get screening mammograms every other year.

These guidelines are determined by weighing a person’s risk of breast cancer against the harm that comes with screening.

Essentially, doctors want to catch breast cancer as early as they can so that the cancer is easier to treat.3 However, about half of women who get mammograms over the course of a decade will get one false positive result.4 This can cause unnecessary anxiety and wasted time and money with further follow-up screenings or biopsies. The USPSTF doesn’t recommend screening for women ages 40 to 49 for this reason—it says that for this age group, these cons are much more prevalent than the pros of finding breast cancer early.

Many other groups, such as the American Cancer Society and American College of Radiology, advocate for screening to start in a woman’s mid or early forties, respectively.56

This newly published JAMA Network Open study sought to look at how these universal recommendations applied to people based on their race and ethnicity, by looking at breast cancer deaths in the U.S. between 2011 and 2020.

The study determined that if all women start getting mammograms at age 50, they have about a 0.3% 10-year cumulative risk of breast cancer death. Using this threshold of risk, the study authors tracked when women of different ethnicities and races would reach that risk level.

It turns out that “there is indeed huge disparity in breast cancer mortality by race and ethnicity,” lead study author Mahdi Fallah, MD, PhD, group leader of the risk-adapted prevention group at the German Cancer Research Center, visiting professor of clinical sciences at Lund University in Sweden, and adjunct professor at the University of Bern in Switzerland, told Health in a statement.

The study found that while white women reached that threshold at age 51—on par with the screening recommendations that begin at age 50—Black women reached the risk threshold at age 42.

For other races and ethnicities, Dr. Fallah and his team found that they weren’t reaching that same risk level until they were older. White women hit the metric at 51, and Hispanic, American Indian, and Alaska Native women at 57. Asian and Pacific Islander women didn’t hit that risk threshold until age 61.

“It’s important to know that breast cancer screening recommendations are just that—recommendations,” Salvatore Nardello, DO, surgical breast oncologist and medical director of the Breast Center at MelroseWakefield Hospital, told Health in a statement.

 

Racial and Ethnic Disparities in Breast Cancer

The study confirms an important fact: breast cancer does not have an equal impact on all races and ethnicities.

“[Black women] are more likely to have genetic mutations putting them at risk for breast cancer. They’re more likely to have a more aggressive cancer subtype that’s a little bit more difficult to treat,” Dr. Omofoye explained. “They are more likely to have dense breast tissue that can make it harder to find cancers. They’re more likely diagnosed at younger ages or at later stages.”

Beyond these genetic or biological differences, societal barriers and biases in healthcare also play a huge role. Black women have fewer opportunities to participate in clinical trials, have less access to care, and may wait longer to start treatment, Drs. Fallah and Omofoye said.

This is why ethnicity and race-based screening recommendations work better than the current “color-blind” ones, Dr. Fallah said.

Early screenings could mean that early-onset cancers are caught sooner, Dr. Fallah said, improving mortality outcomes. Race-specific age guidelines could even spur more conversations about mammography between doctors and patients, Dr. Omofoye posited, as well as increase communication and contact with Black patients.

But one of the study’s limitations, she said, is that we still don’t know if changing these screening guidelines will actually help lower breast cancer mortality rates for Black women.

“While earlier and more frequent breast imaging can help reduce mortality associated with breast cancer, unfortunately, just ensuring all women are getting annual mammograms is not going to completely solve the problem,” Dr. Nardello said.

For one, Black women experience higher mortality rates at every stage of breast cancer, even early ones, Damé Idossa, MD, assistant professor of medicine and breast oncologist in the division of hematology and oncology at the University of Minnesota School of Medicine, told Health. This implies that something beyond just a lack of early screening is going on.

Black women need to have equal access to screening tools beyond mammography, such as MRI, if they need it, she said. These health disparities will also continue to persist as long as Black people face structural racism—this is the theory of “weathering,” namely that the stress of racism takes a physical toll on Black bodies and causes worse health outcomes.

“[Race is] a social construct. It’s not really rooted in biology. Yet we have the consequences of people being labeled as Black has very real health consequences,” Dr. Idossa told Health. “But we can’t ignore the fact that that’s predominantly related to systemic issues.”

While it’s important to focus on things we can change, like screening recommendations, Dr. Idossa noted we have to look past that as well. “I think we need to take a step back and focus on why Black women [are] having higher mortality rates from a disease that, when caught early, should be curable,” she said.

 

A Push for More Personalized Breast Cancer Screenings

There’s no guarantee that adjusting mammogram guidelines based on race will fully address health disparities. But experts agree that the study further emphasizes the importance of more personalized breast cancer screening and care.

“The one-size-fits-all approach to breast cancer screening may not be optimal, equitable, or fair,” Dr. Fallah said. “A risk-adapted approach based on race and ethnicity may provide better outcomes in addressing mortality rates among different populations.

Though 50 is the age generally recommended for starting mammography screening, the USPSTF maintains that the decision to start screening before the age of 50 “should be an individual one.”

Beyond those who are at average risk, there are many women who are considered high-risk because they have genetic mutations or a family history of breast cancer. They should start screening much earlier, Drs. Idossa and Omofoye said.

And the same is true for the other side of the spectrum—starting mammography at 50 may be too early for some.

“For low-risk women with fatty replaced breasts and no family history, their lifetime risk is low enough that the risks of undergoing unnecessary biopsies (false-positives) may be more than their low risk of finding breast cancer,” said Dr. Nardello.

Because of this, people should schedule comprehensive exams with their healthcare providers as early as their 30s, Dr. Omofoye said, in order to determine their personal risk and create a plan for starting screening.

“I’m a huge believer in trying to personalize treatments and screening and all of that as much as we are able to so that we can actually get the right care to the right patient,” Dr. Idossa said. “Hopefully there will be more data in the future to try and help answer this question, and guide us to provide more personalized care.”

 

This article first appeared here.