Age-based mammography screening guidelines may put nonwhite women at risk

According to a study recently published in JAMA Surgery, researchers from Massachusetts General Hospital (MGH) in Boston found current guidelines for breast cancer screening may lead to delayed diagnosis in nonwhite women due to lack of data from racially diverse populations.  

"While a lot of attention has been focused on improving the 'cultural competency' of clinical care (caring for patients in ways that accommodate their cultural and language differences) we are concerned that we haven't paid as much attention to the scientific research process," said David Chang, PhD, MBA, MPH, of the MGH department of surgery and an associate professor of surgery at Harvard Medical School, in a press release. "If the science upon which clinical guidelines are based was not done in a way that respects racial differences, there is little that can be done at the point of delivery to improve patient care." 

The researchers specifically investigated whether applying a single screening guideline issued by the U.S. Preventive Services Task Force (USPSTF) for breast cancer screening to a racially diverse population of women may lead to underscreening and later diagnosis of breast cancer in minorities. The USPSTF currently recommends beginning breast cancer screening at 50 years old in patients at average risk. The researchers, however, doubted these recommendations were created with racially diverse data.  

According to research methods, Chang and his colleagues analyzed data from the Surveillance, Epidemiology, and End Results database of the National Cancer Institute. Women ages 40 to 75 diagnosed with breast cancer between the years 1973 to 2010 participated in the study.  

Study results including the following:  

  • The average age of diagnosis for white women was 59, but was 56 for black women, 55 for Hispanic women and 46 for Asian women.  
  • Compared with 24 percent of white women, 31 percent of black women, 35 percent for Hispanic women and 33 percent of Asian women were diagnosed before age 50.  
  • Higher percentages of black and Hispanic patients (47 and 43 percent) were diagnosed with advanced cancers compared to 37 percent of white patients and 36 percent of Asian patients. 

The researchers noted that enhancing breast screening technologies, screening for breast cancer earlier and improved overall clinical practice may reduce risks and mitigate the cost of exams, which affect minorities more than white patients.  

"The situation with breast cancer is one of the best examples of how science done without regard to racial differences can produce guidelines that would be ultimately harmful to minority patients," Chang said in the press release. "Flawed science can harm more people than flawed clinical care, which is why it is so important to detect and eventually eliminate these sorts of hidden biases in the scientific literature."