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 Compared with white women in the United States, Black women are
younger at breast cancer diagnosis, are diagnosed more often with
hard-to-treat or advanced-stage cancers, and are more likely to die
from breast cancer, the study authors note.
The government-backed U.S. Preventive Services Task Force (USPSTF) -
whose guidelines are widely followed by doctors, insurance companies
and policymakers - calls for regular mammograms for all women every
two years starting at age 50. The task force said women in their 40s
should discuss with their doctors any need for earlier screening.
For the new study, published in Annals of Internal Medicine,
researchers used a computer model to estimate the lifetime impact of
digital mammography screening under different starting ages and
screening intervals for women born in the United States in 1980.
The model compared the benefits of screening to potential harms,
such as false-positive results that would lead to unnecessary
further testing. It used data about breast density, breast cancer
molecular subtypes, age and stage at which treatment is initiated,
as well as non-breast cancer mortality, to evaluate screening
strategies.
As a proxy for racism - which partially accounts for the
disparities, the authors note - the model also considered factors
such as access to medication, delays in treatment, dose reductions,
and discontinuation of treatment.
The model estimates that biennial mammograms for Black women
starting at age 40 would reduce the gap in breast cancer mortality
when compared with white women by 57%. The added risk of false
positives from earlier screenings is balanced by the benefits of
earlier breast cancer detection in this group, the study found.
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More specifically, if all women started getting mammograms at age
50, there would 14.3 breast cancer deaths per 1,000 white women,
compared to 17.6 breast cancer deaths per 1,000 Black women, the
researchers estimate. If screening of Black women started at age 40,
the number of breast cancer deaths per 1,000 in that group would
drop to 15.7, according to the study.
Mammography screening guidelines differ. The American Cancer Society
says women at average risk should begin annual mammography screening
at age 45, although they "should have the opportunity" to start at
age 40. The American College of Obstetricians and Gynecologists
recommends women be offered mammography at 40, and begin screening
no later than age 50.
"Black women are especially encouraged to talk with their clinician
about when it makes the most sense for them to begin getting
screened," Dr. Carol Mangione, vice-chair of the USPSTF, said in an
emailed comment. She said there has not been enough data to make
specific recommendations for different racial and ethnic
populations.
The author of an accompanying editorial in the medical journal said
that while racism in medicine cannot be ignored, categorizing
patients as Black or non-Black may overlook differences in genetic
ancestry and sociodemographics.
"Health inequities are ubiquitous in medicine. We must study race
and racism if we are to eradicate inequity," Dr. David Jones, a
professor of medical ethics at Harvard University, said in the
editorial.
(Reporting by Deena Beasley; Editing by Nancy Lapid, Caroline Humer
and Bill Berkrot)
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