Racial Disparities in Breast Cancer
- According to a study, Black women reach the national average risk for breast cancer at age 42. Thus, it may be reasonable to start screenings at 42 for Black women.
- The risk for breast cancer differs between different racial groups.
- Black women tend to get breast cancer earlier and may develop more aggressive diseases.
- Current breast cancer screening guidelines, which recommend starting regular breast cancer screenings at age 45 or 50, may need to be modified for Black women.
The United States Preventative Services Task Force (USPSTF), a nationwide medical organization that prescribes cancer screening guidelines, recommends beginning breast cancer screening with mammograms at 50 years of age.
Read MoreBreast Cancer
After skin cancer, breast cancer is the most common cancer among women in the United States. According to the American Cancer Society (ACS), we should expect around 300,000 new cases of breast cancer in 2023, with around 43,000 deaths.RELATED: Breast Cancer: Overview
Your Race Is A Risk Factor For Breast Cancer
Within the US, Black women are overall less likely to get breast cancer as compared to white women (Lifetime risk: 12% vs. 14%). However, when Black women do get this cancer, they on average get it at a younger age (56 years old) than white women (59 years old).
Black women also are more at risk for developing this cancer before age 40, which is 10 years before the USPTF recommends people begin screenings.
Additionally, one in five Black women are diagnosed with triple-negative breast cancer, the most aggressive form of breast cancer. This translates into an elevated risk of death from this disease within the Black community.
Deaths From Breast Cancer Are Dropping
There has been a slight increase in the incidence of breast cancer in recent years. The rate of breast cancer deaths, however, has been steadily declining. It has almost halved since 1989.
Better cancer screening, which leads to earlier diagnoses, is paramount to this decline. If Black women tend to be affected by this cancer differently than other women, should they also be screened differently to improve their outcomes?
This question led researchers from China, Germany, Sweden, Switzerland, and Norway on a quest for answers.
Breast Cancer Screening: Current Guidelines
The USPSTF is a leading medical organization that analyzes the best ways for physicians to screen for, prevent, and diagnose many diseases, including breast cancer. The group recommends that an average woman should be screened for breast cancer with a mammogram every 2 years.
Screening should start at age 50 and end at age 74, according to the USPSTF. Women at a higher risk for breast cancer may start screening at 40 years of age. However, the benefits and risks of starting early should be carefully considered by the patient and their physician.
The American Cancer Society (ACS) is another authoritative medical organization that recommends a slightly more nuanced and rigorous regimen for screening.
According to the ACS, women between 40 and 44 years of age can elect to get mammograms, but they do not have to. From 45 to 54 years, they should get yearly mammograms. Women 55 and older can choose between yearly or every-other-year mammograms.
Screening should be continued for all healthy women who are expected to live for at least 10 years after their mammogram.
Even more, Memorial Sloan Kettering Cancer Center, a highly respected name in cancer care, also follows its own guidelines, which differ from the ones noted above.
RELATED: Breast Cancer: Introduction to Prevention & Screening
These differing guidelines highlight the fact that breast cancer screening is not a one-size-fits-all. A patient's individual risk factors, including their race, must be considered while deciding when to start the screening.
And it seems this new study tries to account for those varying risk factors.
The Study: Relationship Between Race & Ethnicity And The Age To Start Breast Cancer Screening
The investigators analyzed over 400,000 women who died of breast cancer in the U.S. between 2011 and 2020 as recorded in the U.S. Mortality Data and the US Surveillance, Epidemiology, and End Results (SEER) database.
They divided the women by their race into six different categories: Hispanic, American Indian & Alaskan Native, Asian & Pacific Islander, Black, White, and Unknown. The data on race were distilled from the demographic information recorded in the database. Black patients made up 15.1% of the patient population.
The researchers then divided the patients into different age brackets and analyzed their risk of death from breast cancer. They found that this risk was strongly influenced by the patients’ race, especially in their 40s. Black women had a significantly higher risk of death than white, American Indian, Alaskan Native, Hispanic, Asian & Pacific Islander women.
When Should We Start Screening Black Women?
To devise the appropriate age to start breast cancer screening, the researchers calculated the average risk of death from breast cancer for all women within the first decade of screening (age 50 to 59). This was estimated to be 0.329%.
They then calculated the age at which women of different races reached this risk. White women reached this risk at age 51. Black women, on the other hand, reached this much earlier (42 years).
The other racial groups reached this risk much later than either white or Black women.
The study thus concluded that breast cancer screenings should start at 42 years for Black women to best help minimize their breast cancer risks.
What Does This Mean?
While a good effort in helping to reduce racial disparities in cancer, the study's conclusion must be viewed with some caution.
A lot of factors can increase the risk of death in a breast cancer patient. Delayed screening, a total lack of screening, delayed and suboptimal treatment, and aggressiveness of cancer can all contribute to this risk. We do not know which combination of these factors caused the deaths reported in the study.
And by extension, we cannot definitively say which factor, such as screening, would lead to improved patient outcomes.
The study nonetheless highlights the fact that breast cancer affects different racial groups in different ways. Black women with breast cancer especially have suboptimal outcomes.
This fact should be taken into consideration when deciding when to start screening Black patients for breast cancer. This may mean that they should be screened at an earlier age than that recommended by current guidelines.
Reflecting on the study, Ms. Simon relates, "I feel both hopeful and frustrated. It’s encouraging to see evidence-based recommendations that could save lives and improve health outcomes for Black women through earlier breast cancer screening. However, it’s frustrating that it has taken so long to recognize this racial disparity in screening guidelines."
She continues, "I believe that even younger screening ages could be considered, given the higher risk of early-onset breast cancer among Black women. It’s frustrating that progress is so slow in addressing these disparities, and it’s important that we continue to push for change and advocate for more comprehensive and equitable healthcare policies."
What Can We Do To Raise Patient Awareness And Conduct Earlier Screenings?
Ms. Simon's extensive work with Black women with breast cancer has given her a deep insight into all the many ways that can be used to educate Black women about their cancer risk and encourage screenings. She suggests the following:
- Patient education: "Healthcare providers can educate their patients about the importance of breast cancer screenings and the recommended age to start screenings. This education can be provided during routine visits, through informational brochures, or online resources."
- Outreach programs: "Outreach programs can be established to reach underserved communities and provide information about breast cancer screenings. These programs can partner with community organizations, such as churches or community centers, to reach a larger audience."
- Telemedicine: "Telemedicine can be used to reach patients who are unable to attend in-person appointments. This can include virtual consultations and appointments, as well as telehealth screenings."
- Mobile screening units: "Mobile screening units can be used to reach patients who may not have access to a healthcare facility or who have difficulty traveling to a clinic. These units can provide mammography screenings and other diagnostic tests."
- Health insurance coverage: "Health insurance coverage can be expanded to cover breast cancer screenings at an earlier age for women who are at higher risk of developing breast cancer. This can help ensure that all women have access to these life-saving screenings."
- Community health clinics: "Community health clinics and programs like the National Breast and Cervical Cancer Early Detection Program can also play an important role in providing access to breast cancer screening for women who may not have access to traditional healthcare services."
Questions To Ask Your Doctor
- What is my risk for breast cancer?
- Does my race put me at an increased risk for breast cancer?
- What other factors do I have that contribute to my risk?
- Do you recommend starting breast cancer screening early?
- What are the benefits of early screening?
- What are the risks of early screening?
Learn more about SurvivorNet's rigorous medical review process.
