Black women should start breast cancer screening early

All women are encouraged to start regular breast cancer screening at age 50, but a one-size-fits-all approach may not benefit everyone, especially black women, new research suggests. Women should start screening eight years ago, around age 42.

The suggestion comes from new research published in the journal in April JAMA network openinvestigated racial disparities in breast cancer mortality and sought to provide suggestions regarding the age at which new racially and ethnically adapted breast cancer screenings should begin.

“There are many guidelines to help people decide when to get screened for breast cancer, but historically, race has actually been taken into account, and race and ethnicity have been strongly considered in those guidelines. I have never done anything like that. Thomas Omophoe, M.D.Associate Professor of Radiology at The University of Texas MD Anderson Cancer Center said: health“But race and ethnicity [a] It has a significant impact on breast cancer outcomes. ”

The disparity in breast cancer mortality between black and white women is evident. Despite a similar incidence, a black woman is 40% more likely to die from the disease than she is. Also, the breast cancer mortality rate for black women under the age of 50 is twice that for white women.

However, insufficient data have hampered potential recommendations for screening recommendations according to race. Even this new study does not make clinical recommendations and offers suggestions on how breast cancer screening can be made more equitable and personalized, as well as how it can be mitigated. Disparities in breast cancer mortality.

What you need to know about why black women may benefit from early breast cancer screening, how race and ethnicity affect a person’s cancer risk, and how to determine the best time to start breast cancer screening is as follows:

Current guidelines for getting started Mammography It comes from the United States Preventive Services Task Force (USPSTF). The group recommends that all women between the ages of 50 and her age 74 have screening mammograms every other year.

These guidelines are determined by weighing the risk of breast cancer against the harms associated with screening.

Basically, doctors want to find breast cancer as early as possible so that the cancer can be treated more easily. However, about half of women who have mammograms over 10 years will have one false-positive result. This can cause unnecessary anxiety and waste time and money on further follow-up screenings and biopsies.The USPSTF does not recommend screening women aged 40 to 49 for this reason. . In this age group, she said, these drawbacks are much more common than the benefits of detecting breast cancer early.

Many other groups, such as the American Cancer Society and the American College of Radiology, advocate starting screening in women in their mid- or early 40s, respectively.

newly released this time JAMA network open This study examines how these universal recommendations apply to people based on race and ethnicity by examining the number of deaths from breast cancer in the United States from 2011 to 2020. I tried

The study found that if all women started having mammograms at age 50, the cumulative 10-year risk of dying from breast cancer was about 0.3%. Using this risk threshold, the study authors tracked when women of various ethnicities and races reached their level of risk.

“There are indeed large disparities in breast cancer mortality by race and ethnicity,” the study found. Mahdi Farah, MD, PhDGroup Leader of the Risk Adaptation Prevention Group at the German Cancer Research Center, Visiting Professor of Clinical Sciences at the University of Lund, Sweden, and Adjunct Professor at the University of Bern, Switzerland. health in a statement.

Studies have shown that white women reach that threshold at age 51, equivalent to screening recommendations beginning at age 50, while black women reach their risk threshold at age 42.

For other races and ethnicities, Dr. Farrar and his team found that they did not reach the same risk levels until they were older. Aboriginal women reached the threshold at age 57. Asian and Pacific Islander women did not reach that risk threshold until age 61.

“It’s important to know that breast cancer screening recommendations are just recommendations.” Salvatore Nardello, DOa surgical breast oncologist and medical director of the Breast Center at Melrose Wakefield Hospital, said: health in a statement.

This study confirms an important fact. Breast cancer does not affect all races and ethnicities equally.

“[Black women] They are more likely to have genetic mutations and are at risk of breast cancer. They are more likely to have more aggressive cancer subtypes that are a little more difficult to treat,” he explained Dr. Omofoye. “They likely have dense breast tissue It can make cancer detection difficult. More likely to be diagnosed at a young age or later. ”

Beyond these genetic or biological differences, social barriers and prejudices in medicine also play a large role. Black women are less likely to participate in clinical trials, have less access to care, and may take longer to start treatment.

This is why ethnicity and race-based screening recommendations work better than current “colorblind” ones, Dr. Farrar said.

Early screening could mean that early-onset cancers are caught early, Dr. Fallah said. Racial age guidelines may further facilitate conversations about mammography between doctors and patients, and may even increase communication and contact with black patients, Dr. Omofoye speculated.

But one of the limitations of the study, she said, is that it remains to be seen whether changing these screening guidelines will actually help reduce breast cancer mortality among black women.

“Earlier and more frequent breast imaging can reduce breast cancer-related mortality, but unfortunately, simply ensuring that all women undergo annual mammograms will not eliminate the problem. It can’t be resolved to a single point,” said Dr. Nardello.

For one thing, black women experience higher mortality from all stages of breast cancer, even the early ones. Dame Idossa, MDassistant professor of medicine and breast oncologist in the Department of Hematology and Oncology at the University of Minnesota School of Medicine, said: health. This means that something beyond the lack of early screening is happening.

Black women should have equal access to non-mammographic screening tools, such as MRIs, when needed, she said. These health disparities will persist as long as black people face systemic racism. This is the theory of “weathering”. So the theory is that the stress of racism takes a physical toll on black bodies and worsens their health.

“[Race is] social construct. It is not rooted in biology. But we have very real health problems as a result of people being labeled as black,” Dr Idosa said. health“But we cannot ignore the fact that it is primarily related to systemic issues.”

While it’s important to focus on things we can change, such as screening recommendations, Dr. Idossa noted that we need to overlook that too. “I think we need to take a step back and focus on why black women are black women. [are] There is a high mortality rate from diseases that are curable if detected early,” she said.

Adjusting mammogram guidelines based on race is no guarantee that health disparities will be completely eliminated. But experts agree that the study further underscores the importance of more personalized breast cancer screening and care.

“A one-size-fits-all approach to breast cancer screening may not be optimal, fair, or equitable,” Dr. Fallah said. “Race- and ethnicity-based risk adaptation approaches may yield better results in addressing mortality in different populations.

Although age 50 is the commonly recommended starting age for screening mammography, the USPSTF states that the decision to start screening before age 50 “should be individual.” claim.

Beyond average-risk people, there are many women who are considered at high risk because they have a genetic mutation or a family history of breast cancer. They should start screening sooner, Dr. said Idsa and Omophoe.

It may be too early to start mammography at age 50.

“For low-risk women with fat-replaced breasts and no family history, the lifetime risk is sufficiently low that the risk of having an unnecessary biopsy (false positive) outweighs the low risk of finding breast cancer. It’s very possible,” said Dr. Nardello.

For this reason, you should schedule a comprehensive examination with your health care provider early in your 30s to determine your personal risk and develop a plan to begin screening, Dr. Omofoye said. I’m here.

“I am a strong believer in personalizing treatments and screenings and all of that as much as possible so that we can actually provide the right care to the right patients,” said Dr. Idossa. “Hopefully, we will have more data in the future to help us answer this question and provide more personalized care.”