According to revised guidelines issued by the United States Preventative Services Taskforce (USPSTF) women at average risk for breast cancer should begin mammogram screenings every other year starting at 40 instead of 50 years old. While Komen believes that lowering the age to start screening is a step in the right direction toward early detection, there are still a number of things to consider for communities historically marginalized in the healthcare system. Discussion is especially important for Black and Latino communities who are more likely to be diagnosed with breast cancer at a younger age and with more aggressive forms of the disease. We spoke with Natasha Mmeje, Director of Community Education & Outreach for Susan G. Komen to learn more about how the draft recommendations could affect these communities:
- Ethnicity and race have a significant impact on breast cancer diagnoses and outcomes. Can you briefly share some information on how breast cancer affects Black and Latino communities differently?
Sure, differences in Black and Hispanic populations compared to the white population can be seen in death rates, age at diagnosis, stage at diagnosis and tumor type. For example, Black women in the U.S. are often diagnosed at a younger age and are about 40% more likely to die of breast cancer than white women. Triple negative breast cancer (TNBC), which is a more aggressive disease and difficult to treat, is more common among Black women in the U.S. than among women of other ethnicities. TNBC may also be more common among Latina women in the U.S. than white women. We know that Black and Hispanic women in the U.S. are more likely to be diagnosed with breast cancer in later stages than white women and with larger and more difficult-to-treat tumors.
- Do you feel the new draft recommendations will help save lives in these communities by providing an earlier diagnosis?
Yes, the new draft recommendation to begin breast cancer screening at age 40 is a step in the right direction. However, the USPSTF only recommends screening take place every other year, and Komen believes screening should be done every year to catch breast cancer as early as possible. It’s important to note that the new draft recommendations are only for women at average risk. For some women at a higher risk, including some in the Black and Latino communities, starting screening at age 40 may not be soon enough. Talking with your family to learn your family health history and talking with your doctor to help you understand your risk can help inform a screening plan that’s right for you. The draft recommendations also state that the change to screening at age 40 every other year could result in 19% more lives being saved. However, we need to be clear that the Black community bears a heavier burden of death from breast cancer.
- The new draft recommendation has also sparked concerns about overdiagnosis and inequitable access to mammograms and treatment. Can you share more about how these issues specifically hinder Black and Latino communities?
While Black women are diagnosed younger and with more aggressive forms of the disease and Latina women are more likely to be diagnosed at later stages, biology is only one part of the story. Black and Hispanic communities face many barriers when accessing care. Komen’s report, Closing the Breast Cancer Gap: A Roadmap to Save the Lives of Black Women in America, found that Black women faced significant barriers to care due to a legacy of systemic racism, implicit bias, and below-standard care. Right now, we’re concerned with ensuring early and accurate diagnoses in these communities.
- Although Black and Latino communities may benefit from an earlier diagnosis, we know that other factors including barriers to care, hinder Black and Latino communities from treatment. Can you share some steps that could eliminate these barriers in the future?
Komen is fully committed to advancing breast health equity for Black and Hispanic communities and other communities experiencing breast cancer inequities now and in the future. Our approach includes:
- Education that empowers people to make informed breast care decisions with their doctor.
- Patient support ensures connection to timely, high-quality care and through patient navigation.
- Workforce development that improves the diversity and cultural sensitivity of health care workers.
- Research that is representative and benefits all, and the creation of policies that promote health equity.
Komen cannot do this work alone. We encourage other organizations to work alongside us to move the needle toward health equity and save more lives.
- Komen has expressed that these age requirements should be lowered to accommodate women at higher risk. Do you think that we can expect to see a lower recommendation in the future?
We think women should have access to breast cancer screening when they and their doctors think it is best for them. Beyond screening, we need public policy that ensures everyone has no-cost coverage for all necessary diagnostic and supplemental imaging. We hope to see current research – including research funded by Komen – translate to risk-based screening recommendations, rather than age, to enable personalized screening and care and ultimately improve outcomes for patients.