A groundbreaking study suggests that Black women might benefit from earlier breast cancer screenings, potentially starting at around 42 years old, instead of 50, as per current guidelines. This recommendation comes from an international team of researchers and follows their analysis of breast cancer mortality rates in the U.S.
Currently, the U.S. Preventive Services Task Force recommends women begin mammogram screenings at 50, with the decision to screen before 50 being an individual one. Various medical organizations, such as the American Cancer Society and Mayo Clinic, support breast cancer screenings starting at 40, with annual mammograms.
Although Black women have a 4% lower incidence of breast cancer than White women, their breast cancer mortality rate is 40% higher.
The message for U.S. healthcare providers and policymakers is straightforward: evaluating race and ethnicity in determining the optimal time to begin breast cancer screenings could positively impact outcomes, according to the study's German author, Mahdi Fallah, a leader at the Risk Group–Adapted Cancer Prevention Group at the German Cancer Research Center in Heidelberg.
Policy-makers could also explore risk-adapted breast cancer screening strategies to combat racial disparities in breast cancer mortality, particularly before the recommended screening age.
Breast cancer screening basics
Breast cancer screenings typically involve mammography, a breast X-ray used to detect early signs of the disease. While the guidelines suggest commencing screenings based on individual risk, race and ethnicity have not historically been critical factors in these decisions.
The research team analyzed data from 415,277 women in the U.S. who died from invasive breast cancer between 2011 and 2020, sourced from the National Center for Health Statistics and analyzed with SEER software from the National Cancer Institute. Studying the data across race, ethnicity, and age, they found a breast cancer mortality rate of 27 deaths per 100,000 persons-years for Black women aged 40 to 49, compared to 15 for White women, 11 for Indian, Alaskan Native, Hispanic, and Asian or Pacific Islander women.
For example, if 100,000 Black women in the U.S. aged 40 to 49 were followed for a year, twenty would die of breast cancer. Synonymously, every year, approximately 0.027% of Black women aged 40 to 49 in the U.S. would die from breast cancer.
Addressing gaps in breast cancer screening and care
While the study suggests that Black women may need to begin breast cancer screenings earlier according to current guidelines, it also calls for further research into the effects of early screening on overall outcomes.
This study corroborates existing evidence of lower breast cancer mortality rates among Black women but cannot conclude the reasons for this discrepancy or determine whether early screening is the primary factor.
Implicit and systemic bias in breast cancer care
Breast cancer is the most common cancer among women in the U.S., with over 43,700 predicted fatalities this year, with the highest rates among Black women.
Aside from biological differences, systemic challenges in healthcare access, treatment, and diagnosis contribute to racial disparities in breast cancer outcomes.
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