Last week, the US Preventive Services Task Force (USPSTF) – an expert panel that issues guidelines on preventive care – published a draft recommendation that all women begin breast cancer screening biannually (every two years) at age 40. This is a ten-year jump from the task force’s previous recommendation to start breast screening at age 50.
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“I think it’s a small step in the right direction after a big step in the WRONG direction,” says Dr. Monique Gary, DO, MSc, FACS – Chief Medical Officer, Grand View Health/Penn Cancer Network. “When its latest recommendations were released in 2016, it did more harm than good in some ways. In addition to advising against breast self-examination, he spurred all these studies… spending valuable resources to prove the harms of screening guidelines for black women. In my opinion, it was tragic, when it is quite evident that delays in screening are one of the many forces at play in our presentation of more advanced disease.”
Many responses to this recent recommendation overlooked a critical detail – it only applies to all people designated female at birth and at average risk of breast cancer. This guidance does NOT apply to women with dense breasts, women of color, or women with a family history of breast cancer. Black women, we are not at average risk!
The disturbing facts*
Black women under age 35 get breast cancer twice as often as white women and die three times as often. Black women ages 40 to 49 are 80% more likely to die of breast cancer than white women. Black women are three times more likely than white women to be diagnosed with triple negative breast cancer – a particularly aggressive subtype of breast cancer associated with poorer outcomes, early relapse, high frequency of metastases and high mortality rate – and have the lowest survival rate at each stage of diagnosis.
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Triple-negative breast cancer is more common in young women, and those diagnosed with breast cancer younger than 40 are twice as likely to have TNBC than those aged 50 to 64. Women diagnosed with TNBC are 53% more likely to be under age 40. TNBC disproportionately occurs in younger black women, who are more likely to have worse prognostic features than older patients at the time of diagnosis.
More than that, though, women with extremely dense breasts have a four to six times greater risk of developing breast cancer than women with mostly fatty breasts. Black women have significantly higher absolute breast density (21.1%) than white women. Black women also have statistically significant volumetric density (44.9%) greater than white women. You don’t know if you have dense breasts until you have a mammogram.
Clearly, waiting to get our first mammograms at age 40 is too late for black women.
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Black women, so what does this mean for us?
As a triple negative breast cancer survivor and CEO and co-founder of TOUCH, The Black Breast Cancer Alliance (TOUCHBBCA), I have read the task force’s updated recommendations with growing anger and concern for our young Black women, especially my own daughters. My family is currently fighting with our health insurers to cover the cost of mammograms for my daughters because we have three generations of breast cancer in our family history.
To get a scientific perspective outside of my intense maternal reaction, I turned to TOUCHBBCA’s brilliant medical advisory board. Their thoughtful overall perspective was that changing the age at first mammogram from 50 to 40 was a significant and long overdue first step for average women. But then again, black women are not average!
Black women, so what can we do to protect ourselves?
Black breast cancer is a different disease, and similarly, black breast health looks different for black women. Too often, young black women, unaware of their risk, are dismissed by doctors and end up with