Do age-based breast cancer screening guidelines put nonwhite female patients at risk?

Age-based breast cancer screening guidelines that do not consider the patient’s race could result in underscreening of nonwhite female patients, according to a new study published in JAMA Surgery.

The authors noted that the U.S. Preventive Services Task Force (USPSTF) currently recommends breast cancer screening begin at age 50 for patients at average risk. “We hypothesize that these guidelines may not be sensitive to racial differences and may be inappropriately extrapolating data from largely white populations for use in racially diverse populations,” wrote lead author David C. Chang, PhD, MBA, MPH, with the department of surgery at Massachusetts General Hospital in Boston, and colleagues.

Chang et al. analyzed data from the Surveillance, Epidemiology and End Results (SEER) Program database from 1973 to 2010. Overall, breast cancer was reported in more than 747,000 female patients. Seventy-seven percent of patients were white, more than 9 percent were black, 7 percent were Hispanic and more than 6 percent were Asian.

The median age at diagnosis, for the entire cohort, was 58. The median age at diagnosis for white patients was 59, while it was 56 for black patients, 55 for Hispanic patients and 56 for Asian patients.

“A higher proportion of patients with breast cancer were diagnosed at younger than 50 years among nonwhite patients (31.0 percent among black, 34.9 percent among Hispanic and 32.8 percent among Asian) than among white patients,” the authors wrote. “If we were to achieve a similar capture rate for nonwhite patients as current guidelines do for white patients at 50 years of age, screening ages would need to decrease to 47 years for black, 46 years for Hispanic and 47 years for Asian patients.”

In addition, more than 46 percent of black patients and more than 42 percent of Hispanic patients present with “advanced disease.” For white patients, that number is more than 37 percent.

“Current USPSTF breast cancer screening recommendations do not reflect age-specific patterns based on race,” the authors concluded. “Moreover, by 2050 most of the United States will be composed of what are now considered to be racial/ethnic minority populations. With this change in population distribution, consideration should be given to adjusting breast cancer screening guidelines. Lastly, culturally sensitive care begins with culturally sensitive science, and we should constantly examine whether scientific findings can be generalized from the majority population to minority populations.”

Chang and colleagues noted that the SEER Program does not capture the entire U.S. population, but its sample size is large enough to support their findings.