Black patients may need breast cancer screenings earlier than what many guidelines recommend

In line with many current medical guidelines, doctors generally recommend that their female patients be regularly screened for breast cancer with mammograms starting at age 50. However, for Black patients, it may be better to start screening years earlier, because their risk of breast cancer death in their 40s is higher than that seen in other racial groups, a new study suggests.

"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," wrote the authors of the new study, published Wednesday (April 19) in the journal JAMA Network Open. "Clinical trials may be warranted to investigate whether changing screening guidelines may alter the trajectory of the disease and have a population impact," particularly among Black female patients, they wrote.

The study authors analyzed data on breast cancer deaths that occurred in the U.S. between 2011 and 2020; in this time frame, more than 415,200 breast cancer deaths were reported. The data were drawn from the National Center for Health Statistics, which keeps records on more than 99% of U.S. deaths. 

Among patients in their 40s, the rate of breast cancer deaths varied significantly by race and ethnicity, the authors found. The rate among Black patients in this age group was 27 deaths per 100,000 people per year. (In epidemiology, this rate can also be written as per 100,000 "person-years.") 

That's compared with 15 deaths per 100,000 person-years in white patients and 11 deaths per 100,000 person-years in American Indian, Alaska Native, Hispanic and Asian or Pacific Islander patients, respectively.

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Overall, across all of the racial and ethnic groups, the average risk of dying from breast cancer between the ages of 50 and 59 was about 0.329%, the researchers calculated. 

"However, this risk level is reached at different ages for women from different racial/ethnic groups," Dr. Mahdi Fallah, a co-author of the new study and leader of the Risk Adapted Cancer Prevention Group at the German Cancer Research Center in Heidelberg, Germany, told CNN in an email. 

"Black women tend to reach this risk level of 0.329% earlier, at age 42. White women tend to reach it at age 51, American Indian or Alaska Native and Hispanic women at age 57 years, and Asian or Pacific Islander women later, at age 61," Fallah said. Although patients of American Indian, Alaska Native, Hispanic and Asian or Pacific Islander heritage had similar death rates due to breast cancer in their 40s, the team found that they still crossed this threshold of risk at different ages.   

The authors concluded that their "findings suggest that health policy makers and clinicians could consider an alternative, race and ethnicity-adapted approach in which Black female patients start screening earlier," around 42 years old instead of 50.

The authors also noted that, while some groups of medical experts recommend starting breast cancer screening at age 50, others say patients should consider earlier start times.

For example, the American Cancer Society currently recommends that women at average risk for breast cancer begin screenings at age 45 but have the option to start as young as 40. The American College of Obstetricians and Gynecologists also recommends that patients be offered screenings as early as 40 and begin screenings no later than 50. 

However, many others guidelines recommend starting screenings at age 50 and frame starting younger than that as an individual decision. 

The age at which patients start screenings is likely not the only factor that could explain why Black patients see high rates of breast cancer deaths in their 40s, the study authors emphasized. However, they propose that shifting screenings earlier for Black patients could be a way to begin addressing the problem.

Dr. Rachel Freedman, a breast oncologist at Dana-Farber Cancer Institute who was not involved in the new study, said it's hard to say from this study whether earlier screenings would make the difference. 

"This study confirms that the age of breast cancer-mortality is younger for Black women, but it doesn't confirm why and if screening is even the main reason," Freedman told CNN in an email. "We have no information about the types of cancers women developed and what treatment they had either, both of which impact mortality from breast cancer." 

In short, from the data included in the study, the researchers can't conclusively say when any of the patients started being screened for breast cancer or how that was linked to their risk of death from the disease, she said. 

Read more in CNN.