Will delaying mammography screening to age 50 worsen breast cancer disparities among African American women?
Underwood J, Stark A, Swain M, Newman L, and Petersen S. Will delaying mammography screening to age 50 worsen breast cancer disparities among African American women? Gynecol Oncol 2017; 145:142.
Objective: To determine the impact of mammography exposure in African-American women age 40-49 years by documenting both benign breast disease and breast cancer diagnosis. Method: A total of 4,695 women with imaging outcome of suspicious lesions Breast Imaging Reporting and Data System 4 (BIRADs 4) between December 2007 and 2011 were identified from the Radiology Information System. Women with history of breast cancer were excluded. Information on demographic and clinicopathologic variables was retrieved manually by reviewing electronic medical records. Data from 500 of these women have been validated and statistically evaluated; 101 women had either declined to disclose their racial/ethnic heritages or belonged to the other racial/ethnic heritages. These women were removed from further analyses. All statistical analyses were performed using SAS version 9.4. Results: A total of 253 African-American women (AA), of whom 15% (n = 38) were between ages of 40 and 49 years, and 146 white women (WA), of whom 8.9% (n = 13) were between ages of 40 and 49 years, contributed to this study. Differences in the distributions of the clinicodemographic risk factors for breast cancer did not reach the level of statistical significance between the two groups of women. In addition, there were no statistical differences in screening mammogram utilization or length of time between mammograms previous to the index mammogram. Among women 40-49 years of age, 21.6% (n = 11) were diagnosed with breast cancer, of whom 90.9% (n = 10,) were AA (5 were diagnosed with DCIS and 5 with invasive breast cancer) and 9.1% (n = 1) WA. (See Table 1.) Conclusion: The United States Preventative Services Task Force (USPSTF) guidelines have been drafted with the objective of reducing the burden of unnecessary screening; however, these guidelines have not been adjusted for the higher incidence rates of triple negative BC in AA women and/or the increased risk of invasive BC among younger AA women,age 40-45 years. Preliminary findings from this ongoing study suggest that screening mammogram in AA women age 40-49 years is essential for early detection and improved treatment outcome. Racial/ethnic disparity in breast cancer treatment outcomes has been narrowed through extensive education and improved awareness about early detection. Concerns about the long-term consequences of the USPSTF guidelines have been expressed.