The US Preventive Services Task Force currently recommends that breast cancer screening start at age 50 years, regardless of race or ethnicity.
But a new analysis of breast cancer deaths supports a "race and ethnicity-adapted" approach to breast screening, with Black women starting screening 8 years sooner — at age 42.
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," say the authors, led by Tianhui Chen, PhD, with Zhejiang Cancer Hospital, Hangzhou, China.
The study was published online April 19 in JAMA Network Open.
Laurie R. Margolies, MD, chief of breast imaging at the Dubin Breast Center of the Mount Sinai Tisch Cancer Center in New York City, agreed.
Black women get breast cancer at a much younger age, are less likely to be diagnosed with early breast cancer, and are more likely to die of breast cancer, explained Margolies, who was not involved in the study.
"That's why the guidelines that say begin at age 50 are flawed and so dangerous," she said in an interview with Medscape Medical News. "This study is really important to highlight that we're missing an opportunity to detect and treat breast cancer early in the Black population."
The current study explored the optimal race- and ethnicity-specific ages to initiate breast cancer screening to address racial disparities in breast cancer mortality.
Using a nationwide population-based cross-sectional study design, the team analyzed data on 415,277 women who died of breast cancer in the US from 2011 to 2020.
The cohort was 75% White, 15% Black, 7% Hispanic, 3% Asian or Pacific Islander, and <1% Native American or Alaska Native. A total of 115,214 women (28%) died before age 60. The team calculated the 10-year cumulative risk of breast cancer–specific death by age and by race and ethnicity.
For those aged 40 to 49, breast cancer mortality was highest among Black women (27 deaths per 100,000 person-years), followed by White women (15 deaths per 100,000 person-years) and American Indian/Alaska Native, Hispanic, and Asian/Pacific Islander women (11 deaths per 100,000 person-years).
If breast screening started at age 50 for the entire population, the mean 10-year cumulative risk of dying from breast cancer would be 0.329%. Black women reached this risk threshold level at age 42, whereas non-Hispanic White women reached the threshold at age 51, American Indian/Alaska Native and Hispanic women at age 57, and Asian/Pacific Islander women at age 61.
If screening started at age 45 for all women, the mean 10-year cumulative risk of breast cancer death would be 0.235%. Black women reached this risk threshold level at age 38, non-Hispanic White women at age 46, Hispanic women at age 49, Asian/Pacific Islander women at age 50, and American Indian/Alaska Native women at age 51.
If screening started at age 40 for all women, with a mean 10-year cumulative risk of 0.154%, Black women would reach this risk threshold at age 34, White women at age 41, Hispanic women at age 43, and American Indian/Alaska Native and Asian/Pacific Islander women at age 43.
The Task Force also recommends that women in their 40s make an individual decision with their doctor on screening start date. But Chen and colleagues conclude that failure to consider race and ethnicity in breast cancer screening guidelines "may pose a significant risk for greater harm to a group already at increased risk.
"Changing guidelines based on readily available risk factors, such as race and ethnicity, is possible and may be the first, yet important step toward a personalized and fair screening program," the team explains.
Margolies believes individualized screening recommendations will likely come, but first, all women should start screening at age 40 instead of age 50.
"Most American women are starting in their 40s, or starting at 40, because we know what the current guidelines are," she said. "The question that this study doesn't answer is, is age 40 young enough for the Black population? Maybe it should be 35."
The study was supported by grants from the National Key Research-Development Program of China and from the Ten-Thousand Talents Plan of Zhejiang Province and by Start-Up Funds for Recruited Talents in Zhejiang Cancer Hospital. Chen and Margolies have disclosed no relevant financial relationships.
JAMA Netw Open. Published online April 19, 2023. Full text
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