Why we need new breast cancer screening guidelines for black women

Deaths from breast cancer in the U.S. are trending downward. However, the improvement is uneven across racial groups. Non-Hispanic Black women are 40% more likely to die from cancerTrusted Source than Non-Hispanic white women. A new study investigates addressing this disparity with new screening mammography recommendations for Black women.

The study finds that biennial mammography screening starting at age 40 could reduce the racial disparity by 57%.

The study’s conclusions derive from extensive modeling performed by the Cancer Intervention and Surveillance Modeling Network (CISNET)Trusted Source.

The study appears in the Annals of Internal Medicine.

Understanding the problem

According to the study, “Screening mammography guidelines do not explicitly consider racial differences in breast cancer epidemiology, treatment, and survival.”

The study’s senior author, Jeanne S. Mandelblatt, MD, MPH, who works with CISNET and is a professor of oncology and medicine at Georgetown Lombardi Comprehensive Cancer Center in Washington, D.C., explains: “Black women have higher rates of aggressive cancers at younger ages than white women, and treatments for those types of tumors are not as effective. However, even when we account for cancer subtypes, mortality is higher for Black women largely due to factors that are ultimately rooted in racism.”

Dr. Mandelblatt cites “access to medication, delays in treatment, dose reductions, and discontinuation of treatment — all factors that have been shown to be suboptimal more often in Black than white women.”

Lead author Christina Hunter Chapman, MD, MS, of the Department of Radiation Oncology at the University of Michigan, describes the concept behind the research:

“There is an increasing focus on eliminating race-based medicine. However, calls to end race-based medicine that ask for the immediate cessation of any discussion on race are not likely to eliminate racial disparities. Carefully selected solutions for health inequity may involve tailoring interventions to specific racial groups.”

Dr. Chapman told Medical News Today, “Breast cancer and other health disparities have been described for decades, but there has not been as much emphasis on solutions to reduce these disparities.”

Dr. Chapman added, “Black women were not sufficiently included in screening mammography trials, so simulation modeling represented the next best research approach to identifying equitable screening strategies.”

President and CEO of the Black Women’s Health Imperative, Linda Goler Blount, MPH, told MNT: “I suppose a computer model is better than nothing, but it speaks volumes that after all these decades, we still don’t have a study that examines this issue that includes significant numbers of Black women.” She added, “What the model can’t do is incorporate or account for the lived experiences of Black women.”

Blount asserted that what is needed are randomized control trials, saying: “These have been proposed many times, but NIHTrusted Source [National Institutes of Health] refuses to fund them. This will be the only way we understand how the lived experiences of Black women influence their risk and treatment outcomes outside the impact of racism.”

Striking a balance in screening

Some people have expressed concerns about exposure to radiation during mammograms. Modern digital mammography, says Dr. Sarah Zeb of Johns Hopkins Medical Imaging, involves a minimal amount of radiation that is within safety guidelines. “A mammogram is safe as long as the facility you go to is certified by the regulating agencies,” says Dr. Zeb.

Another often-cited potential harm is that mammograms are fallibleTrusted Source. They may miss abnormalities obscured by tissue, resulting in false negatives. Mammograms may also deliver a false positive result, requiring follow-up tests and doctor visits.

Blount said, however, that 3D, or digital breast tomosynthesis, “is the superior technology and reduces call-backs, which helps deal with the overdiagnosis issue. Even the [U.S. Preventive Services Task Force] had to admit that false-positives were not a huge stress-inducer or deterrent for women.”

Source: Medicalnewstoday.com

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