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Black women need earlier breast cancer screenings

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A new study published in the journal JAMA Network Open suggests that Black women should start screening for breast cancer at a younger age than current guidelines recommend. The study’s authors, an international team of researchers, suggest that clinical trials may be necessary to investigate whether screening guidelines should recommend that Black women start screening at age 42 instead of 50.

Breast cancer screenings are typically performed using a mammogram, and the US Preventive Services Task Force recommends biennial screening for women starting at age 50. However, many medical groups, including the American Cancer Society and Mayo Clinic, recommend that women start screening with a mammogram every year starting at age 40.

The new study found that even though Black women have a 4% lower incidence rate of breast cancer than White women, they have a 40% higher breast cancer death rate. The study’s authors recommend that clinicians and radiologists consider race and ethnicity when determining the age at which breast cancer screening should begin.

The American Cancer Society’s recommendations appear to align with the findings in the new study, as the research highlights how screening guidelines should not be a “one-size-fits-all policy,” but rather help guide conversations that patients and their doctors have together. The study’s authors suggest that a fair and risk-adapted screening program may be associated with optimized resource allocation.

The researchers analyzed data on 415,277 women in the United States who died of breast cancer from 2011 to 2020 and found that when the breast cancer mortality rate for Black women in their 40s is 27 deaths per 100,000 person-years, meaning that 27 out of every 100,000 Black women aged 40-49 in the US die of breast cancer compared with only 15 deaths per 100,000 in White women and 11 deaths per 100,000 in American Indian, Alaska Native, Hispanic and Asian or Pacific Islander women.

“We, here at the American Cancer Society, strongly recommend that all women consider a screening mammogram from the age of 40 onwards, and that means having a discussion with their doctor,” said Dr. Arif Kamal, the American Cancer Society’s chief patient officer, who was not involved in the new study.

The study’s authors highlight that racial disparities in breast cancer mortality may result from implicit bias in medicine and access to care issues that go beyond biology. They suggest that health policymakers pursue equity, not just equality when it comes to breast cancer screening as a tool to help reduce breast cancer death rates.

“This study confirms that the age of breast cancer mortality is younger for Black women, but it doesn’t confirm why and if screening is even the main reason. We have no information about the types of cancers women developed and what treatment they had either, both of which impact mortality from breast cancer,” Dr. Arif Kamal said.

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