New study suggests black women should be screened early for breast cancer

CNN
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New research on breast cancer deaths raises questions about whether black women should be screened at younger ages.

An international team of researchers studyIt was published Wednesday in the journal JAMA Network Open.

of U.S. Preventive Services Task Force – A group of independent medical professionals provide recommendations to help guide physician decisions – Screening every 2 years is recommended for women over 50. American Cancer Society and mayo clinichas already emphasized that women have the option of starting annual screening with a mammogram from age 40.

Although black women have a 4% lower incidence of breast cancer than white women, 40% higher mortality from breast cancer.

“The takeaway message for U.S. clinicians and health policy makers is simple: Clinicians and radiologists should consider race and ethnicity when deciding when to start screening for breast cancer. said the author of the new study, Risk-Adaptive Cancer Prevention Group Leader The German Cancer Research Center in Heidelberg, Germany, said in an email.

“Also, health policy makers can consider risk-adapted approaches to breast cancer screening to address racial disparities in breast cancer mortality, particularly mortality before the recommended age for mass screening.” said Dr Farrar. Lund University Adjunct professor in Sweden. University of Bern of Switzerland.

Breast cancer screening is usually Mammogramwhich is an x-ray of the breast that doctors examine to look for early signs of breast cancer.

“While screening guidelines do recommend that women base their decision on when to initiate screening for cancer on the basis of their risk of developing cancer, race and ethnicity are among the traditional factors that influence these decisions. There was no” Dana-Farber Cancer Institutesaid in an email that it was not involved in the new research.

of The American Cancer Society currently recommends It is recommended that all women consider mammogram screening for breast cancer risk starting at age 40, and annual mammograms for women ages 45 to 54. If you are 55 or older, you can switch to biennial screening if you choose.

However, “we are in the process of updating breast cancer screening guidelines, and in a way that will reduce the disparity, we will look at how screening guidelines may differ for women of different races and ethnic groups, as well as other risk factors.” We’re looking at the scientific literature for whether there is, based on the risk-outcome disparity,” says Robert Smith. Senior Vice President, Cancer Screening “We are investigating these issues closely,” said an email from the American Cancer Society, which was not involved in the new study.

The American Cancer Society’s recommendations appear to be consistent with the results of new research. This study emphasizes that screening guidelines are not a “one size fits all” policy, but rather help guide the conversations that patients and physicians have together. .

“Here at the American Cancer Society, we strongly encourage all women to consider a screening mammogram after age 40. This means talking to your doctor,” said Dr. Arif Kamal of the American Cancer Society. said. Chief Patient Officerwas not involved in the new study.

“The authors emphasize that age 50 may be a little later,” Kamal said of the study’s findings on when to start breast cancer screening. For one woman, we agree.”

Researchers from China, Germany, Sweden, Switzerland, and Norway analyzed data on 415,277 women in the United States who died from breast cancer between 2011 and 2020.analyzed by National Cancer Institute SEER statistics software.

When the researchers looked at data by race, ethnicity, and age, breast cancer mortality for women in their 40s was 27 per 100,000 person-years for black women, compared with 100,000 for white women. It turned out to be 15 and 11 per person. per 100,000 of her Native American, Alaskan Native, Hispanic, Asian or Pacific Islander women.

“Given a breast cancer mortality rate of 27 per 100,000 person-years among black women in their 40s, this means that 27 of 100,000 black women aged 40-49 in the United States will die during one year of follow-up. “It means dying of breast cancer. In other words, 0.027% of black women ages 40 to 49 die of breast cancer each year,” Farrar said in an email.

In general, women in the United States have an average risk of dying from breast cancer in the 10 years between ages 50 and 59 of 0.329%.

“But this risk level is reached at different ages for women of different racial/ethnic groups,” said Farrar. Caucasian women tend to arrive at age 51, Native American or Alaska Native and Hispanic women at age 57, and Asian or Pacific Islander women later, at age 51. Age 61 .

Therefore, the researchers determined that if breast cancer screening is recommended for women at age 50, black women should start at age 42.

However, “the authors did not have information about whether the women included in this study had actually been screened for mammography or how old they were. For example, many women who participated in this study You may have actually been screened between the ages of 40 and 49,” Friedman of Dana-Farber Cancer Institute said in an email.

“This study confirms that breast cancer mortality among black women is younger, but does not confirm why or whether screening is the primary reason. There is no information about what treatments were received, but both have an impact on mortality from breast cancer,” she said.

The harm of starting mammograms at a young age is that it increases the risk of false-positive screening results, leading to unnecessary follow-up tests and emotional stress.

However, the researchers wrote in their study, “The added risk of false positives from early screening may be balanced by the benefits associated with early detection of breast cancer.”

They also wrote that health policy makers should seek equity as well as equality when it comes to breast cancer screening as a tool to reduce breast cancer mortality.

Equity in breast cancer screening means that “everyone is screened from the same age, regardless of risk level. This means that screening will be offered to ,” the researchers wrote. “We believe that an equitable and risk-adapted screening program may also be associated with optimized resource allocation.”

Given the higher overall mortality rate of breast cancer among black women, and black women are more likely to be diagnosed at a younger age compared to other ethnic groups, the new research is “timely and pertinent.” Dr. Kathie-Ann Joseph, Surgical Oncologist Perlmutter Cancer Center at NYU Langone A professor of surgery and public health at the NYU Grossman School of Medicine said in an email.

“One might argue that early screening can lead to increased recalls and unnecessary biopsies, but women have about a 10% chance of being recalled for additional imaging and One to two percent of cases require a biopsy, which is very low,” said Joseph. No one was involved in the new research.

“This has to be compared to lives saved by previous screening mammograms,” she said. “We certainly want to prevent deaths, but early screening can help women of all races and ethnic groups reduce major surgeries and chemotherapy, which affect their quality of life. I would also like to point out that there are other advantages because you can.”

breast cancer most common cancer among women In the US, excludes skin cancer. About 43,700 women are estimated to die from the disease this year, according to the American Cancer Society, and black women have the highest mortality rate from breast cancer.

despite being a black woman 40% more likely Kamal of the American Cancer Society said the disparity in mortality was not the result of black women not following current mammogram guidelines.

Rather, implicit prejudices in medicine play a role.

“In the United States, nationally, there is no difference in mammogram screening rates between black and white women. In fact, nationally the number is about 75%. We can see that 3 out of 4 get their mammograms on time,” Kamal said.

However, there are multiple points after a patient is diagnosed with breast cancer that may not have the same quality of care or access to care as other patients.

“For example, black women are less likely to be encouraged to enroll in clinical trials, not because of a stated conflict of interest. There is parity between women and white women,” Kamal said.

“What we need to understand is where implicit and systemic biases held by patients, their caregivers, and their families can exist. We have policies and even practices that prevent people from accessing quality health care fairly and equitably,” he said.

In addition, black women Almost three-fold increased risk of triple-negative breast cancer. specific type of cancer It tends to be more common in women under the age of 40, progresses more rapidly than other types of invasive breast cancer, and offers fewer treatment options.

Black women also tend to have denser breast tissue than white women. Dense tissue in the breast can make it difficult for radiologists to identify breast cancer on mammograms, and women with dense breast tissue have a higher risk of breast cancer.

But such biological differences among women are only part of a larger debate about racial disparities in breast cancer, Kamal said.

“There is a systemic problem, a problem of access to care that goes beyond biology,” he said. “The reality is that cancer affects everyone and there is no discrimination. It is after diagnosis that discrimination happens and that is what we need to focus on.”