Q: I am African American and heard that there have been changes made to the mammogram recommendations for my ethnic group. Can you explain this?
A: You have asked an excellent question and raise an even better point. We have long thought that African-American women were at higher risk of developing breast cancer, especially more aggressive forms of it. Now the evidence is conclusive enough that two leading medical societies – the American College of Radiology (ACR) and the Society of Breast Imaging (SBI) – have modified their screening recommendations on several fronts.
Before we get to the recommendations, let’s look at the research results that led to them:
• African-American women are 42 percent more likely to die from breast cancer than non-Hispanic white women, even though the rates of breast cancer are about the same in both populations.
• African-American women have a two-fold increased incidence of aggressive breast cancers, like triple negative, than other women.
• African-American women are less likely to be diagnosed with early stage breast cancer (Stage-1), yet are twice as likely to die from these early stage cancers.
• African-American women have a higher risk of BRCA-1 and BRCA-2 genetic mutations.
More detailed information can be found here: www.acr.org.
Therefore, the ACR and SBI recommend that all women, but especially women of African descent, undergo a risk cancer assessment such as the (Tryer-Cuzick or BRCAPRO models) at age 30, and if they have above average risk factors, they should begin screening at age 30, instead of age 40.
They also recommend that screening mammography be done with 3D units (digital breast tomosynthesis, or DBT), not just regular digital units.
In addition, they recommend that all women who have been diagnosed with breast cancer in the past, receive adjunct surveillance with breast MRI.
Here is a link to the recently published research paper, if you want to read the details: www.jacr.org/article.
Michael J. Ulissey, M.D., is a partner at the Breast Diagnostic Centers of Auburn and Federal Way. In addition to taking care of patients locally, he continues to participate in research as an adjunct professor at the University of Texas Health Sciences Center. You can reach him at firstname.lastname@example.org.