ROYAL OAK, Mich. – The best age to start screening for breast cancer has been the subject of much debate, with some guidelines recommending age 50, others 45 or 40.
Researcher Dr. Murray Rebner said the later guidelines are putting Black women at a disadvantage by ignoring some very key facts about their risk.
“They’re not doing them any benefit by delaying African American women from being screened before the age of 50. It does them no good,” said Rebner.
Rebner is a Beaumont diagnostic radiologist specializing in breast imaging. He said the Black Lives Matter movement inspired him and a fellow researcher to take a hard look at the challenges Black women face in his field of specialty.
“We wanted to focus it on how African American women were dealing with getting screened and what were some of the issues that are unique to the African American population,” said Rebner.
Their resulting paper was published in the Journal of Breast Imaging.
The journal explains why starting screening at age 50 is often too late for Black women. While Black women are slightly less likely to get breast cancer, they’re significantly more likely to die from it.
Studies find 23 percent of breast cancers in Black women are diagnosed before age 50 compared to 16 percent of all breast cancers in White women.
“They’re far more likely to get breast cancer under the age of 50 than White women. The other thing is, they’re also far more likely to get a very aggressive type of breast cancer we call triple negative, and that has a poor prognosis and doesn’t do as well as some of the other subtypes,” explained Rebner.
Triple negative breast cancer makes up 21 percent of the cases in Black women compared to 10 percent in White women.
“Given an earlier onset, and a more aggressive type of cancer, and we felt that this population, you know, needs to be screened earlier, starting at the age of 40, at least, and also that they need to be screened annually because these cancers grow faster, they’re more aggressive. And if you’re going to do something good for them, you have to catch it early,” said Rebner.
Rebner says the BRCA2 genetic mutation which dramatically raises the risk of breast cancer is also more common in Black women than White women who aren’t of Ashkenazi Jewish descent.
There are other challenges too. Rebner said a lot of African American women don’t have a primary care doctor, making them less likely to be referred for screening. They’re also less likely than white women to be referred for supplemental screening with MRI.
Rebner said the American College of Radiology now recommends all women take a risk assessment, preferably before age 30. It asks a series of questions to help determine your individual risk and the best time to start screening.
For the risk assessment tool, click here.
Screening guidelines are important because they guide doctors' recommendations and can determine if screening is covered by insurance.
“Our job is to help all people, the entire population, you know, we want everybody to benefit from a good technology,” said Rebner.
He urges African American women to push for appropriate screening.
“The bottom line message is that they need to take responsibility for their own health care. They need to be aware of their own risks, and they should initiate discussions with their health care providers as to what’s going to do them the most good and have discussions about when to get screened,” said Rebner.