How Does Race Impact Recommendations for Breast Cancer Screening?

An investigation published in JAMA Network Open explained how race and ethnicity might impact recommendations for breast cancer data. Based on the researchers’ analysis, they provided evidence-based race and ethnicity-adjusted recommendations for initiating breast cancer screenings.

The study collected information on female breast cancer patient deaths in the United States between 2011 and 2020. Of the 415,277 patients analyzed in this study, 0.5% were American Indian or Alaskan Native, and 2.9% identified as Asian or Pacific Islander. Black and White patients comprised 15.1% and 74.6% of the individuals analyzed, respectively. Finally, Hispanic patients were 6.8% of the patient population.

Researchers sectioned mortality by age and analyzed the risk of breast cancer mortality for individuals 40–49 years old. Black patients had the highest risk in this category, with 27 deaths per 100,000 person–years. Comparatively, the death rate for White patients was nearly 50% less at 15 deaths per 100,000 person–years. Beyond that, the sum of American Indian or Alaskan Native, Hispanic, and Asian or Pacific Islander deaths was 11 per 100,000 person–years for people 40–49 years old.

The study recommends breast cancer screenings when the ten-year cumulative risk of breast cancer death is 0.329%. Based on that standard and further analysis, the researchers determined that the current standard of initiating screening at 50 is insufficient.

The clinicians in the study determined that Black patients should begin screening at 42 years old because that is when they reach the indicated risk. Meanwhile, the adjusted age for White women is closer to the current standard, at 51 years old.

Furthermore, recommendations for American Indian or Alaskan Native women recommend screenings at 57 years old. Finally, the data collected indicates that Asian or Pacific Islander females could potentially delay screenings until 61.

Regarding current screening protocols, the researchers in the study note, “Health policymakers may consider the alternative, risk-adapted approach in which individuals, such as Black females, who are at high risk are screened earlier. If the cost of more intensive screening in individuals at high-risk matters and if the US seeks to generate guidelines that are associated with equity in mortality risk across racial and ethnic groups, the initial screening may be postponed in individuals, such as non-Hispanic Asian and Pacific Islander females, at low risk.”

“This may decrease potential harms associated with unnecessary screenings in this population. This may be an important step toward a more optimized, equitable, and personalized BC screening and may help mitigate the current long-standing disparity of early-onset BC mortality in populations, especially Black females, at increased risk,” they concluded.