To date, official recommendations on when and how often a woman should have a screening mammogram, have been based on risk factors (such as age, a family history of breast cancer, a personal history of radiation to the chest), genetic testing (the BRCA test, for example), or troubling results from a previous biopsy. Race and ethnicity have not officially factored into the equation — yet.
Does race matter when it comes to screening mammograms?
A recent study by Harvard doctors at Massachusetts General Hospital reinforces prior data suggesting that race and ethnicity can be a separate risk factor for breast cancer, and should be taken into account when advising women on when and how often to have a screening mammogram.
The authors studied almost 40 years of data in a massive, publicly available US research information bank called the Surveillance, Epidemiology, and End Results (SEER) Program, and identified over 740,000 women ages 40 to 75 with breast cancer. They wanted to know if the age and stage at diagnosis differed by race.
It did. White women’s breast cancers tend to occur in their 60s, with a peak around 65. However, black, Hispanic, and Asian women’s breast cancers tended to occur in their 40s, with a peak around 48. In addition, a significantly higher proportion of black and Hispanic women have advanced cancer at the time of diagnosis, when compared to white and Asian women.
This fits with prior studies, including a separate analysis of data from SEER as well as the Center for Disease Control’s National Program of Cancer Registries (NPCR). They found that non-Hispanic white women tend to have the least aggressive breast cancer type, while black women tend to have the most aggressive type, as well as more advanced disease at diagnosis.
Basically, there are reliable data to suggest that we take race and ethnicity into account when we counsel patients about when to start mammograms and how often to have them. While many doctors are aware of the data and are sharing this information with patients, it’s not part of “official” guidelines.
So what are the official guidelines for screening mammograms?
Breast cancer screening has become an area of some controversy, with at least six different US organizations offering varying opinions, more or less in the same ballpark (give or take 10 years, that is). For the average woman without the risk factors listed above, the recommendations range from
Every woman over age 40 should have a mammogram every year, but, it’s a shared decision-making process so talk about it first (American College of Obstetrics and Gynecology)
Start at age 45 and then every year until age 55, then every other year (American Cancer Society)
Start screening mammograms at age 50 and have them every other year (United States Preventive Services Task Force).
This variability seems confusing, but what is consistent is that all guidelines recommend a shared decision-making process. That means a woman should talk with her doctor to determine when to first have a screening mammogram, and how often she should have one.
Reasons a woman might not want to start screening mammograms at age 40
Apart from some awkwardness and discomfort, why wouldn’t a woman want to start screening mammograms at age 40? Every screening test carries some risk, including unnecessary additional imaging and biopsies. The idea is that by starting screening later, the likelihood of catching cancer early isn’t outweighed by the risks of screening. Many of my patients have gotten that dreaded callback after their mammogram: “We see something that may be cause for concern and need you to return for additional images.” This is nerve-racking and involves additional radiation exposure. If the area is still worrisome, then a biopsy may be done. Most biopsies are negative, and even when positive, we don’t know for sure that all low-grade, localized cancers are going to progress. We treat them when we find them for sure, but it’s possible that not everyone will benefit from lumpectomy and radiation or mastectomy.
What do women need to know about screening mammograms?
Doctors should counsel women accurately about their risks and benefits for cancer screening, and while guidelines are helpful, they are only guidelines. We need to know where the guidelines came from, what data was used to create them, and — most importantly — what data were not used to create them. In the case of breast cancer screening, race and ethnicity have not yet been formally included in the existing guidelines, and women need to be aware of that and what it means for them.
Related Information: A Guide to Women’s Health: Fifty and forward
Below are spiritual recipe for health and wellness: Matthew E. McLaren
Whoever pursues righteousness and love finds life, prosperity and honor. Proverbs 21:21 NIV
Instead, speaking the truth in love, we will grow to become in every respect the mature body of him who is the head, that is, Christ. Ephesians 4:15 NIV
Hatred stirs up conflict, but love covers over all wrongs. Proverbs 10:12 NIV
For I am convinced that neither death nor life, neither angels nor demons, neither the present nor the future, nor any powers, neither height nor depth, nor anything else in all creation, will be able to separate us from the love of God that is in Christ Jesus our Lord. Romans 8:38-39 NIV
The second is this: ‘Love your neighbor as yourself.’ There is no commandment greater than these. Mark 12:31 NIV
I love the Lord, for he heard my voice; he heard my cry for mercy. Because he turned his ear to me,
I will call on him as long as I live. Psalm 116:1-2 NIV
Whoever does not love does not know God, because God is love. 1 John 4:8 NIV
If I speak in the tongues of men or of angels, but do not have love, I am only a resounding gong or a clanging cymbal. 1 Corinthians 13:1 NIV
Love the Lord your God with all your heart and with all your soul and with all your mind and with all your strength. Mark 12:30 NIV
For his anger lasts only a moment, but his favor lasts a lifetime; weeping may stay for the night, but rejoicing comes in the morning. Psalm 30:5 NIV
For, Whoever would love life and see good days must keep their tongue from evil and their lips from deceitful speech. They must turn from evil and do good; they must seek peace and pursue it. 1 Peter 3:10-11 NIV
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