Breast Cancer Screening Recommendations Not Completely Reflective of Race, Age
Investigators accessed the SEER database and reviewed outcomes for patients with malignant breast neoplasms diagnosed from 1973 through 2010.
Editor's note: This article was corrected to reflect the USPSTF recommendation is a biennial breast cancer screening at age 50, not annual.
Current breast cancer screening recommendations may be insensitive to racial differences and do not accurately reflect race-based age-specific patterns, according to a research letter submitted to JAMA Surgery.
The US Preventive Services Task Force (USPSTF) recommends that women at average risk begin biennial breast cancer screenings at age 50 years, but guidelines may have been based on data extrapolations from mainly white populations, therefore leading to suboptimal management for this patient population as a whole.
Investigators accessed the Surveillance, Epidemiology, and End Results (SEER) database to evaluate the outcomes of 747,763 women with malignant breast neoplasms diagnosed from 1973 through 2010. The median age at diagnosis was 58.0 years, and the race/ethnic distribution was 77.0% white, 9.3% black. 7.0% Hispanic, and 6.2% Asian.
Results showed that the median age at the time of diagnosis was 59 years for white, 56 years for black, 55 years for Hispanic, and 56 years for Asian women.
Further analysis showed that a greater proportion of nonwhite women — 31.0% for black, 34.9% for Hispanic, 32.8% for Asian — were younger (younger than 50 years) when their breast cancer was diagnosed compared with white patients (23.6%) (P <.001); the recommended age for screenings would need to be adjusted significantly for nonwhite women to attain a similar capture rate as white women.
The distribution patterns of age at diagnosis peaked in the 60s for white patients compared to 40s for nonwhite patients, and nonwhite patients presented with more advanced disease at time of diagnosis compared with white patients.
Findings show that current recommendations for breast cancer screenings do not correctly represent age-specific patterns based on race in the United States, and will only become even less accurate as the racial/ethnic minorities grow and represent a greater portion of the population. The authors concluded that “consideration should be given to adjusting breast cancer screening guidelines. […] we should constantly examine whether scientific findings can be generalized from the majority population to minority populations.”
Stapleton SM, Oseni TO, Bababekov YJ, Hung YC, Chang DC. Race/ethnicity and age distribution of breast cancer diagnosis in the United States [published online March 7, 2018]. JAMA Surg. doi: 10.1001/jamasurg.2018.0035