In the United States, breast cancer is the most common diagnosed malignancy in women. Yet in November 2009, the United States Preventive Services Task Force (USPSTF) published a set of guidelines for breast cancer screening that was notably different from their last update in 2009.
Previously, the updates supported an annual mammogram for women ages 40-49 years. Incredibly, the current guidelines recommend that women ages 50-74 years undergo screening every two years rather than annually. And more importantly, the decision to actually have a mammogram screening is now left in hands of the patient and her physician.
The recommendation that women younger than age 50 should forgo annual mammograms is akin to a death sentence for African-American women, as they are most likely to develop breast cancer at an earlier age. Rather than make that recommendation, the USPSTF should review the groundswell of evidence that clearly identifies the breast cancer disparities that exist between African-American and other women. Of critical importance is that the USPSTF should revise and rethink its recommendation to reflect the best interest of those women who are most vulnerable to this disease.
Nationwide, the American Cancer Society reports that while the incidence of breast cancer is lower in African-American women, the mortality rate is significantly higher. While breast cancer may affect any woman (and even some men), it is particularly dangerous for African-American women. They are generally diagnosed at an earlier age with an advanced stage and an aggressive phenotype of breast cancer. In fact, the breast cancer tumors in African-American women are more likely to be hormone receptor negative and of a higher pathology grade, with both conditions understood to be poor prognostic factors.
It is quite notable that in African-American women between ages 35 and 45, the incidence and mortality rate is higher than for other women. For many, this is the age where they are contributing members of society and may have productive careers and/or major parental responsibilities. Yet it’s at this age for African-American women that they may not be able to live up to their fullest potential because of the devastating impact of this disease.
There must be clear emphasis placed on those situations in which early diagnosis and intervention is vital for survival. A key example is in the early detection of breast cancer, where widespread adoption of this USPSTF for African-American women is a sure-fire death sentence. It is critical, then, that we take into account group specificity before concluding that annual mammograms are counter-indicated and that screening every two years should be the standard. The need for stronger standards is unambiguously the case of breast cancer in African-American women.
Claudia M. Davis RN, MN, Ph.D., is with the Department of Nursing, College of Natural Sciences, California State University San Bernardino