Earlier breast cancer screening for Black women could reduce mortality disparities
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Establishing biennial mammography screening beginning at age 40 years could reduce breast cancer-associated mortality by 57% among Black women, according to study results published in Annals of Internal Medicine.
The benefit-harm ratio with biennial screening starting at age 40 years among Black women was comparable to that of white women screened biennially between the ages of 50 and 74 years, researchers noted.
“Black women have been dying of breast cancer at higher rates than the overall population for decades. The fact that they are diagnosed at younger ages, are more likely to have the aggressive triple-negative subtype, and are less likely to receive high-quality treatment suggested that they might benefit from a different screening schedule,” Christina Hunter Chapman, MD, MS, affiliate researcher in the Center for Clinical Management Research at the VA Ann Arbor Healthcare System and assistant professor of radiation oncology at University of Michigan School of Medicine, told Healio. “Randomized trials to answer this question would either be extremely costly, take many years or might not be feasible altogether, so a simulation modeling study was embarked upon, as these models have been used extensively to inform modern screening recommendations.”
Current mammography screening guidelines do not consider racial differences in breast cancer epidemiology, treatment and survival.
Chapman and colleagues sought to compare the tradeoffs of screening strategies among a 1980 U.S. birth cohort of Black women and white women under current screening guidelines. They used an established model from the Cancer Intervention and Surveillance Modeling Network to simulate screening outcomes using race-specific inputs for subtype distribution; breast density; mammography performance; age-, stage- and subtype-specific treatment effects; and nonbreast cancer-associated mortality.
Results showed biennial screening for Black women between the ages of 45 and 74 years appeared most efficient, while biennial screening between the ages of 40 and 74 years was most equitable.
Black-white mortality disparities could be reduced by 57% by initiating mammography screening 10 years earlier among Black women. In addition, researchers found that the less effective treatment was for Black women, the more intensively they could be screened before risk-benefit tradeoffs were lower than those experienced by white women.
A single model design was one limitation of the study.
“It was surprising, to some extent, to find the degree to which treatment disparities influence screening outcomes, but this makes sense conceptually,” Chapman said. “Access and receipt of high-quality treatment matters when considering screening schedules, as the benefit-to-harm tradeoffs of screening differ substantially depending on how likely Black women are to receive modern therapies.”
More research in this arena is planned, Chapman said.
“We plan to perform additional studies that will examine screening outcomes using digital breast tomosynthesis, calculate costs and investigate how suboptimal screening adherence might influence disparities in screening outcomes,” she told Healio.
For more information:
Christina Hunter Chapman, MD, MS, can be reached at University of Michigan School of Medicine, 1500 E. Medical Center Drive, Ann Arbor, MI 48109; email: chapmach@med.umich.edu.
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