The Need For Equity in Breast Cancer Screening

Researchers have debated for several years whether some health screening guidelines are set at ages too late to prevent cancer among people of color or even save lives. A study published in the journal JAMA Network Open, suggests this is true for Black women and breast cancer.

The U.S. Preventive Services Task Force recommends that women with average risk of breast cancer, between 50 and 74, get a mammogram every two years. They should speak with their healthcare providers if they want to begin screening before age 50. Other recommendations suggest starting breast cancer screening at earlier ages. These differences have led to variations in what healthcare providers tell their patients and at what ages insurers will cover mammograms. The guidelines are also based on clinical trial data that historically has underrepresented U.S. women of color.

Despite compelling evidence suggesting Black women especially may require more race-specific recommendations, screening policies are also homogenous. While Black women have a 4% lower incidence rate of breast cancer, they have a 40% higher breast cancer death rate when compared to White women. Black women also tend to be diagnosed at younger ages than White women and with more advanced disease, lowering their survival chances. Furthermore, studies have shown that Black women have nearly a three-fold increased risk of triple-negative breast cancers, which are harder to treat and have a poorer prognosis.

In this latest study, an international team of researchers studied US breast cancer death data from the National Center for Health Statistics. The data included the race, ethnicity, and ages of 415,277 women who died of invasive breast cancer between 2001 and 2020. The researchers analyzed the data in increments of years. They found that the rate of breast cancer deaths for women in their 40s was 27 per 100,000 people- years for Black women compared to 15 deaths per 100,00 for White women and 11 deaths per 100,000 for American Indian, Alaskan Natives, Hispanic, Asian, and Pacific Islander women.

The researchers also analyzed the average risk level of dying from breast cancer at different ages. They found Black women tend to reach it at age 42, White women at age 51, American Indian, Alaskan Native, Hispanic women at age 57, and Asian and Pacific Islander women at age 61.

Based on their findings, the researchers advised that health policymakers should pursue equity, not just equality when setting breast cancer screening guidelines. Equality means everyone has equal access to breast cancer screening regardless of risk level. Equity means setting screening policies based on known risk levels, including racial and ethnic factors.

The researchers also say clinical trials are needed to see whether lowering the screening guidelines for Black women to age 42 saves lives. Until such trials are completed, the study's lead author says healthcare providers need to recognize the disparities in breast cancer mortality that exist and consider race and ethnicity as risk factors when determining when patients should begin getting mammograms.