By Steve Blanchard - April 24, 2023
Black women may need to be screened for breast cancer earlier than women of other races, details of a new study say. In the journal JAMA Network Open, a team of international researchers said clinical trials may be warranted to investigate whether screening guidelines should recommend Black women start screening at the age of 42 rather than 50.
Moffitt Cancer Center, the National Comprehensive Cancer Network and the American College of Radiology recommend annual screening for women with an average breast cancer risk beginning at age 40. Those with risk factors, like a family history of the disease, should speak to their doctor about starting routine screenings even earlier, sometimes as early as age 30. Medical professional organizations agree that screening mammograms decrease breast cancer deaths; however, published guidelines differ in their recommendations for when women should begin screening mammograms. Some guidelines recommend starting mammograms as late as age 50.
According to Dr. Bethany Niell, section chief of breast imaging at Moffitt, more lives are saved by performing mammograms every year beginning at age 40. And all women, regardless of race, should be evaluated by age 30 to determine if they are at an increased risk of developing breast cancer.
"Screening mammography guidelines that recommend starting mammograms later, like age 50, disproportionately impact minority women."- Dr. Bethany Niell, Diagnostic Imaging and Interventional Radiology
“Minority women are also more likely to present at younger ages with more aggressive types of breast cancer,” Niell said. “Screening mammography guidelines that recommend starting mammograms later, like age 50, disproportionately impact minority women. I recommend that women undergo screening mammograms each year beginning no later than age 40 so we can save the most lives.
“And even if it hasn’t been a year since your last mammogram, if you feel a lump, you should immediately make an appointment with your health care provider,” Niell said.
Moffitt offers screenings at the Richard M. Schulze Family Foundation Outpatient Center at McKinley Campus and at Moffitt Cancer Center at International Plaza.
Even though Black women have a 4% lower incidence rate of breast cancer than white women, according to the American Cancer Society, they have a 40% higher breast cancer death rate.
The researchers in the JAMA study — from China, Germany, Sweden, Switzerland and Norway — analyzed data on 415,277 women in the United States who died of breast cancer in 2011 to 2020. That data on invasive breast cancer mortality rates came from the National Center for Health Statistics and was analyzed with the National Cancer Institute’s SEER statistical software.
When the researchers examined the data by race, ethnicity and age, they found that the rate of breast cancer deaths among women in their 40s was 27 deaths per 100,000 person-years for Black women compared with 15 deaths per 100,000 in white women and 11 deaths per 100,000 in American Indian, Alaska Native, Hispanic, Asian and Pacific Islander women.
It’s important to recognize disparities across ethnic and racial backgrounds, Niell added.
“Hispanic white, Hispanic Black and non-Hispanic Black women are more likely to die from breast cancer than non-Hispanic white women,” Niell said.
According to Dr. Kimberley Lee, a medical oncologist in Moffitt’s Department of Breast Oncology, there are large differences in the way in which Black women receive treatment for breast cancer compared to their white counterparts. In fact, the disparities are so great that more Black women are likely to die of breast cancer, specifically HER2 negative breast cancer, even though it is more treatable.
"We know that Black women are more likely to be undertreated or mistreated and less likely to get the drugs or surgery that they need."- Dr. Kimberley Lee, Department of Breast Oncology
“My work is focused on care delivery,” Lee said. “My work focuses on the science of how we get appropriate care to all people. We know that Black women are more likely to be undertreated or mistreated and less likely to get the drugs or surgery that they need. I am focusing on how we give them the things we know that work and focusing on that care delivery piece.”
The study authors recommend weighing race and ethnicity when determining the appropriate age to start breast cancer screening. It’s important for all women to talk to their doctors about what is right for them.
Using data on racial and ethnic disparities in breast cancer mortality, a risk-adapted approach to different starting ages for #breastcancer screening with those at high risk screened earlier may help address disparities. https://t.co/ccqsXhOY6R— JAMA Network Open (@JAMANetworkOpen) April 19, 2023