Earlier breast cancer screening recommended for Black women

Key takeaways:

• Breast cancer mortality rates at age 40 to 49 years are much higher for Black women than for others.

• Black women reach a 10-year cumulative risk threshold at age 42 years vs. age 61 years for Asian women.

  

Compared with other racial and ethnic groups, Black women have high breast cancer mortality at ages 40 to 49 years and could benefit from screening for the disease before the current recommended age of 50 years, according to researchers.

In addition, women of other racial and ethnic groups reach the current 10-year cumulative risk threshold for mass screening at ages older than 50 years, according to study data.

“The current one-size-fits-all policy to screen the entire female population from a certain age may be neither fair and equitable nor optimal. … The current situation is an example of what happens when race and ethnicity are not considered in guidelines. This may pose a significant risk for greater harm to a group already at increased risk,” Tianhui Chen, MD, PhD, from the department of cancer prevention at Zhejiang Cancer Hospital and the Institute of Basic Medicine and Cancer at the Chinese Academy of Sciences in Hangzhou, China, and colleagues wrote. “To optimize the benefit of screening, risk-adapted starting ages of screening based on known and readily available risk factors, such as race and ethnicity, may be recommended. We aimed to provide evidence for risk-adapted starting age of screening by race and ethnicity.”

In this nationwide population-based cross-sectional study, published in JAMA Network Open, researchers analyzed U.S. mortality data from the National Center for Health Statistics for 415,277 breast cancer-specific deaths between 2011 and 2020 among women in the U.S. Researchers determined risk-adapted starting ages for breast cancer screening by race and ethnicity based on 10-year cumulative breast cancer-specific death risk.

Overall, 0.5% of women included in the study were American Indian or Alaska Native, 2.9% were Asian or Pacific Islander, 15.1% were Black, 6.9% were Hispanic and 74.6% were white. Among the cohort, 27.7% of women died before age 60 years.

Breast cancer mortality per 100,000 person-years for those aged 40 to 49 years was 27 deaths among Black women, 15 deaths among white women and 11 deaths for American Indian or Alaska Native, Hispanic, and Asian or Pacific Islander women all together.

Although the U.S. Preventive Services Task Force advises that individual women in their 40s should decide with their clinician whether they should start screening, the Task Force recommends mass breast cancer screening to begin at age 50 years for all women based on a 10-year cumulative breast cancer death risk of 0.329%. Researchers determined that Black women reach this risk threshold at age 42 years; white women at age 51 years; American Indian or Alaska Native and Hispanic women at age 57 years; and Asian or Pacific Islander women at age 61 years.

If researchers screened for breast cancer starting at 45 years old for all women with mean 10-year cumulative risk of 0.235%, Black women would reach this risk threshold 7 years earlier compared with all other racial and ethnic groups. In addition, if breast cancer screening began at age 40 years for all women with a mean 10-year cumulative risk of 0.154%, Black women would reach this threshold 6 years earlier compared with all other racial and ethnic groups.

“If the cost of more intensive screening in individuals at high-risk matters and if the U.S. seeks to generate guidelines that are associated with equity in mortality risk across racial and ethnic groups, the initial screening may be postponed in individuals, such as non–Hispanic Asian and Pacific Islander females, at low risk. This may decrease potential harms associated with unnecessary screenings in this population,”the researchers wrote. “This may be an important step toward a more optimized, equitable, and personalized [breast cancer] screening and may help mitigate the current long-standing disparity of early onset [breast cancer] mortality in populations, especially Black females, at increased risk."

Editor’s Note: This article was updated on April 24, 2023, to clarify that USPSTF recommends women begin screening for breast cancer every other year starting at age 50 years, and that women in their 40s should decide with their clinician whether they should start screening.