The US Preventive Services Task Force (USPSTF) recently released its long-anticipated guidelines on breast cancer screening, lowering the screening age from 50 years to 40 years biennially. However, there has been growing concern over the adequacy of breast cancer screening guidelines for Black women. Despite advances in medical knowledge and technology, these guidelines often fall short of addressing the unique needs and risks faced by Black women when it comes to breast cancer. In fact, although they are a step forward, these recommendations still fail Black women who are more likely to get breast cancer before 40 and have a 41 percent higher mortality rate from breast cancer than white women.
BlackDoctor.org spoke with Linda Goler Blount, president of the Black Women’s Health Imperative and steering committee member for the White House Initiative on Women’s Health Research. As an epidemiologist, Blount shed light on why existing guidelines may not be sufficient and what steps can be taken to improve breast cancer screening outcomes for Black women.
The Problem with Current Guidelines
USPSTF made recommendations in 2009 and 2015 to raise the age of screening mammography from 40 to 50 years. This decision was based on the belief that the harms of false positives and unnecessary treatments outweighed the benefits of early detection.
However, these guidelines fail to consider several key factors that are particularly relevant to Black women.
“Back in 2016, when we were trying to get the PALS Act passed, which would put a moratorium on raising the age of screening guidelines, we showed that if you raise the age, then another 1300 Black women are going to die every year. This is because Black women get breast cancer on average five to seven years younger than white women,” Blount shares.
Moreover, the research on which these guidelines are based often does not include a diverse representation of Black women.
“Researchers on the task force said that their recommendations are based on science, which is absolutely true. However, these studies were conducted in Sweden, China, and Canada, and did not include any Black women. So, our position was, how can you raise the age to start looking for breast cancer when we know Black women are getting it younger? We also know that half of women, including Black women, have dense breast tissue, which can make it harder to detect cancer. Black women are also twice as likely to get triple-negative breast cancer compared to white women. If we wait to start looking for breast cancer, those with triple-negative breast cancer will be in serious trouble, especially considering the challenges of late diagnosis,” Blount adds.
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The Impact of Incomplete Information
The lack of research specific to Black women’s experiences with breast cancer has significant implications.
“One important point I want to emphasize is that being Black does not inherently cause Black women to have higher mortality rates. Black women and white women with breast cancer receive the same treatment and should have the same outcomes. However, the 40 percent mortality rate among Black women is due to a lack of standard care….Lack of research conducted on breast cancer in Black women…hinders our understanding of why Black women develop breast cancer at younger ages,” Blount notes.
In turn, Blount says Black women may not receive the appropriate screenings or may not receive them at the right time, leading to
