New screening guidelines recognize high breast cancer risk in African American women
New breast cancer screening guidelines recognize for the first time that African American women are at high risk for breast cancer and should be screened accordingly.
The guidelines, published by the American College of Radiology (ACR) and the Society of Breast Imaging (SBI), propose that all women, especially Black women and those of Ashkenazi Jewish descent, be evaluated for breast cancer risk no later than age 30 so that those at higher risk can be identified and benefit from screening earlier than age 40.
The guidelines also recommend that women previously diagnosed with breast cancer should now be screened with magnetic resonance imaging (MRI).
As they did before, the two organizations continue to recommend that women of average risk begin screening at the age of 40 years old.
“The latest scientific evidence overwhelmingly supports a continued general recommendation of starting annual screening at age 40. It also supports augmented and earlier screening for many women. These updates will help save more lives,” Debra Monticciolo, MD, chair of the ACR Breast Imaging Commission, said in a press release.
According to the most recent American Cancer Society’s “Cancer Facts & Figures for African Americans,” breast cancer is the most commonly diagnosed cancer among African American women, with an estimated 30,700 new cases diagnosed in 2016 alone.
Like the pattern seen for white women, breast cancer incidence rates among African American women increased rapidly during much of the 1980s largely due to increased detection by mammography screening.
However, while rates generally stabilized in white women, they continued to increase in African-Americans, even though at a slower rate of 0.5 percent per year between 1986 and 2012.
As a result, incidence rates in both African American and white women converged in 2012. The continued increase in incidence rates in African American women could be because of the rising prevalence of obesity in this population.
Breast cancer incidence rates are also higher among African Americans than whites for women younger than 45. The median age of diagnosis is 58 for Black women compared to 62 for white women.
Other factors also contributed to the ACR/SBI reclassification of African American women, including statistics such as African-American women are 42 percent more likely to die from breast cancer than non-Hispanic white women despite comparable incidence rates, and Black women have twice the risk of triple-negative breast cancers, an aggressive subtype of the disease.
In addition, Black women are less likely to be diagnosed with stage 1 breast cancer but are twice as likely to die of early breast cancer. They also have a higher risk of BRCA1 and BRCA2 genetic mutations, known to carry a higher risk of the disease.
“Since 1990, breast cancer death rates dropped 23 percent in African American women — approximately half that in whites. We changed our approach to help save more African-American women and others at higher risk from this deadly disease,” said Wendy B. DeMartini, MD, FSBI.