Black Women Should Screen for Breast Cancer Starting at Age 42, Study Suggests

Fact checked by Nick Blackmer

• Black women are at greater risk of dying from breast cancer than people of other races and ethnicities.

• Screening Black women for breast cancer starting at 42 years old could help clinicians identify cancer cases and reduce deaths, according to a new study.

• There are many causes for disparities in breast cancer outcomes, but promoting earlier screening for Black women could be a valuable first step, the authors say.

Black women younger than 50 are nearly twice as likely to die from breast cancer as their White counterparts, despite having a 4% lower incidence of the disease.

The U.S. Preventive Services Task Force (USPSTF) currently recommends that women begin getting mammograms at age 50, while other major medical organizations recommend they start younger. According to a large new study, screening Black women for breast cancer starting at age 42 can help minimize racial disparities in breast cancer deaths.

“Guidelines for screening actually already do recommend basing a woman’s time to initiate screening based on the risk of developing cancer, though race and ethnicity have not been traditional factors that go into these decisions,” Rachel Freedman, MD, MPH, a medical oncologist at Dana-Farber Cancer Institute and associate professor of medicine at Harvard Medical School, told Verywell in an email.

The study analyzed data from more than 415,000 breast cancer deaths in U.S. female patients between 2011 and 2020. They found that 27 of every 100,000 Black women in their 40s die of breast cancer each year. That’s higher than the 15 deaths per 100,000 among all U.S. females.

For women in their 50s, the average risk of dying from breast cancer over 10 years is 0.329%, according to the study. But each racial/ethnic group reaches that risk threshold at a different age.

The researchers suggested that Black women should really begin at 42 years old; White women at 51; American Indian and Alaska Native and Hispanic women at 57; and Asian and Pacific Islander women at 61.

“The current one-size-fits-all policy to screen the entire female population from a certain age may be neither fair and equitable nor optimal,” the authors wrote.

The study does not make clinical recommendations, but it could be used to help inform providers and policymakers to create screening guidelines based on “equity not just equality,” according to the authors.

Some major medical groups recommend a younger starting age, depending on a patient’s individual risk factors. The American Cancer Society recommends women start annual screening at 45 years old but may start at age 40. The American College of Obstetricians and Gynecologists recommends screening starting at age 40 and no later than age 50.

How Much Will Early Screening Actually Reduce Breast Cancer Deaths?

The new study didn’t track whether any of the subjects received a mammogram when they were 40 to 49 years old, nor what kind of breast cancer they had, Freedman noted. Researchers will need to run clinical studies to further investigate how screening ages factor into cancer mortality.

“This study confirms that the age of breast cancer mortality is younger for Black women, but it doesn’t confirm why and if screening is the main reason,” Freedman said. “We have no information about the types of cancers women developed and what treatment they had either, all of which impact mortality from breast cancer.”

In general, early detection can help clinicians treat cancer before it becomes life-threatening.

“Mammography works because it reduces mortality,” Maxine S. Jochelson, MD, a radiologist and Chief of the Breast Imaging Service at Memorial Sloan Kettering, told Verywell.

Research indicates that high-quality screening can lead to a 40% reduction in breast cancer mortality. When breast cancer is detected in people younger than 40, patients are less likely to need a mastectomy and chemotherapy.

When breast cancer is detected in younger people, it tends to be an aggressive subtype called triple-negative. To detect these cancers in women in their 40s, screening may need to be more sensitive and more frequent than for people who are older.

Related:Triple-Negative Breast Cancer More Deadly for Black Women

Additionally, Black women tend to have denser breast tissue than women of other racial and ethnic groups. When breast tissue is dense, radiologists may have a harder time finding cancerous growths from a standard mammogram, Jochelson said.

Under new guidelines, the Food and Drug Administration (FDA) now requires mammography centers to notify patients if they have dense breast tissue. Getting an ultrasound in addition to routine mammographies could increase the odds of detecting cancer in these patients and decrease false positives.

In its recommendations, the USPSTF cites the potential downsides of false positives and unnecessary biopsies as reasons against recommending routine screening earlier than age 50. The authors suggest that women in their 40s must weigh “a very important but infrequent benefit” against the downsides to “make an informed decision to begin screening.”

The new study suggests that the benefit may outweigh the potential harms for Black women.

“It’s much more stressful to present with a three-centimeter breast cancer than to have an ultrasound or an extra couple of images,” Jochelson said. “I think the task force completely overplayed that and I don’t think that’s a good reason not to do mammography.”

Related:Breast Cancer Screening Guidelines

What Contributes to Breast Cancer Death Disparities?

There are many factors beyond screening that contribute to inequalities in breast cancer outcomes. Black people are less likely to have access to high-quality cancer treatments, routine testing, and insurance coverage for cancer care.

Besides, environmental factors like chemical exposure could contribute to the development of aggressive triple-negative breast cancer. Black people tend to have disproportionately high levels of toxic chemicals linked to breast cancer risk in their bodies.

Some research indicates there are other underlying biological factors that make breast cancer more aggressive or more deadly in Black women. Researchers are still investigating which biological factors contribute to these disparities.

In the meantime, encouraging early and frequent screening is an important step for addressing breast cancer mortality, Jochelson said.

Improving equitable access to care could help reduce disparities. For instance, mobile screening vans equipped with mammography machines can bring screening services to people who may not otherwise access them. Improving screening technology to easier detect cancerous cells in people with dense breast tissue can also ensure clinicians catch and treat cancer early.

Jochelson said all women—not just those with a BRCA mutation or a family history of breast cancer—should work with their provider to create an individualized screening plan.

“The most common cause of developing breast cancer is being a middle-aged woman,” Jochelson said. “Women should all get screened. Even if they don’t have any family members that have had breast cancer, they’re still at risk.”

Read Next:Breast Ultrasound vs. Mammography: Which Is Best?

If you are unsure when to start screening for breast cancer, consult with your primary care provider. They can assess your risk for cancer and make recommendations for screening based on your family history, age, and other factors.