If you are a Black woman, when should you get a mammogram? While most doctors advise women to start at age 50, a study shows that is might be wise if Black women started screenings at age 40. A National Cancer Institute found that deaths from breast cancer could be reduced by 57 percent if mammograms begin at age 40 as compared to 10 years later. This new research raises questions about whether Black women should begin mammogram screenings at age 40.
One of the concerns among health professionals is that death rates for Black women are 40% higher than white women. Mammogram screening guidelines have not changed or accounted for the role of race and its impact on breast cancer treatment, length of survival and deaths among Black women.
“There is an increasing focus on eliminating race-based medicine,” explains the study’s lead author Christina Hunter Chapman, MD, MS, adjunct assistant professor in the Department of Radiation Oncology at the University of Michigan. “However, calls to end race-based medicine that ask for the immediate cessation of any discussion on race are not likely to eliminate racial disparities. Carefully selected solutions for health inequity may involve tailoring interventions to specific racial groups.”
Why Black Women Should Begin Mammogram Screenings at Age 40?
The model used in this study considered self-reported race, as well as breast density, distribution of breast cancer molecular subtypes, age-, stage-, and subtype-specific treatment effects, and non-breast cancer mortality for Blacks and whites. Using all of these data, the model compared the benefits and harms of different screening strategies in Black women to those for white women screened biennially from ages 50-74.
“For Black women, three biennial screening strategies (beginning at age 40, 45, or 50) yielded benefit-to-harm ratios that were greater than or equal to those seen in white women who started screening at age 50,” explains Chapman. “Among those three strategies, initiating mammograms at age 40 yielded the greatest mortality reduction and reduced Black-white mortality disparities by 57 percent. This approach is consistent with the US Preventive Services Task Force’s overarching guidance for when women may want to consider beginning biennial mammography.”
In regard to earlier screenings, “we need to be careful about increased radiation exposure, etc. But if there is a strong family history and other kinds of things that we might be concerned about, we should definitely be an advocate for our patients for early screenings if they’re warranted based on the current guidelines,” said Aminah Keats, ND, FABNO, a practicing naturopathic physician at Capital Integrative Health in Bethesda, Maryland, and vice president on the board of directors for the Oncology Association of Naturopathic Physicians (OncANP), in a previously published interview in Natural Medicine Journal.
“Black women have higher rates of aggressive cancers at younger ages than white women, and treatments for those types of tumors are not as effective. However, even when we account for cancer subtypes, mortality is higher for black women largely due to factors that are ultimately rooted in racism,” says the study’s senior author, Jeanne S. Mandelblatt, MD, MPH, professor of oncology and medicine at Georgetown Lombardi Comprehensive Cancer Center, and a principal investigator with CISNET.
“Therefore, in our analyses we accounted for differences in treatment attributable to racism, including access to medication, delays in treatment, dose reductions, and discontinuation of treatment — all factors that have been shown to be sub-optimal more often in Black than white women,” Mandelblatt adds. “We hope this provides new information to help develop equity-focused recommendations for Black women and address a long-standing deficit in breast cancer screening guidelines due to the lack of data.”
The researchers believe this project highlights how this new data could increase equity in cancer outcomes. “In the future, the harms of racism in medicine may be better rectified by developing interventions that use more direct measures of racism as instead of race,” Chapman concludes. “However, using socioeconomic status alone as a proxy for race would not be appropriate in a study like ours given that racial disparities in breast cancer are observed across socioeconomic strata.”
This article is provided by the Institute for Natural Medicine, a non-profit 501(c)(3) organization, partnered with the American Association of Naturopathic Physicians. INM’s mission is to transform healthcare in America by increasing both public awareness of naturopathic medicine and access to naturopathic doctors for patients. INM believes that naturopathic medicine, with its unique principles and practices, has the potential to reverse the tide of chronic illness that overwhelms existing health care systems and to empower people to achieve and maintain their optimal lifelong health. INM strives to achieve this mission through the following initiatives:
- Education – Reveal the unique benefits and outcomes of naturopathic medicine
- Access – Connect patients to licensed naturopathic doctors
- Research – Expand quality research of this complex and comprehensive system of medicine
Stewart is an award-winning editor, food and health journalist and best-selling author of Eating Between the Lines, the supermarket shopper's guide to the truth behind food labels (St. Martin's Press).