Since breast cancer screenings became widespread in the 1980s, the death rate for women has dropped 43 percent. But the rate for Black women has only dropped by 23 percent. Two weeks ago, the New American College of Radiology and the Society of Breast Imaging released new guidelines for early breast cancer assessment that officially recognize this racial disparity—calling for Black women to be assessed as early as age 30.
“We’ve known about the higher death rate in Black women for some time—I’ve published on these disparities,” said UPMC Radiation Oncologist Dr. Felicia Snead. “Folks used to think it was because they didn’t go to the doctor, and so presented at a later stage—but even controlling for that, there seems to be some genetic or biological factors.”
One of those, which the ASR/SBI noted in its announcement of the new screening guidelines, is that African American women have a higher risk of BRCA1 and BRCA2 genetic mutations than those of Western European ancestry. These carriers are at much higher risk for breast cancer.
Black women also have a two-fold higher risk of developing aggressive “triple negative” tumors. The key to the new guidelines, said Dr. Snead, is risk assessment. And given the heightened risk, African American women should be assessed earlier.
“Not all women are at the same risk. These recommendations are specific to high-risk patients—women who have a known genetic mutation, or have been exposed to carcinogens, or have a family history,” she said. “There are calculations to assess patients risk—for African American women, that assessment should be made earlier, beginning at 30.”
Dr. Snead’s research, conducted with colleagues at Georgetown University, yielded results indicating there were longer lag times for African American patients, compared to non-Hispanic White women between diagnosis and treatment for chemotherapy, radiation and surgery. “Because surgery is often the initial treatment modality offered to newly diagnosed women, it is imperative that care is delivered in a timely fashion, as delay may affect the potential benefits of adjuvant therapy, radiotherapy, and chemotherapy, which could adversely affect outcomes,” Dr. Snead’s report read. “The National Breast and Cervical Cancer Early Detection Program (NBCCEDP) set a predefined standard of having a diagnosis within 60 days of an abnormal screening test result and initiation of treatment within 60 days of diagnosis.”
But Dr. Snead said though her recommendations and those of the ASR/SBI are directed toward caregivers and clinicians getting assessment conversations started with patients earlier, patients need to bring it up, as well.
“It really helps when patients know their family history,” she said. “For generations, we didn’t talk about the ‘C’ word. Auntie just got sick. Well, what happened to her? People need to understand it’s not automatically gloom and doom. It can be treated if diagnosed early.”
On another front, Pitt researcher Dr. Margaret Rosenzweig is in the middle of a longitudinal study of 179 Black women and 179 White women at six sites undergoing chemotherapy to determine if “ineffective communication contributes to a racial disparity in dose reduction and early therapy termination.”
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