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The Landmark Series—Addressing Disparities in Breast Cancer Screening: New Recommendations for Black Women

  • Breast Oncology
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Abstract

Randomized, clinical trials have established the efficacy of screening mammography in improving survival from breast cancer for women through detection of early, asymptomatic disease. However, disparities in survival rates between black women and women from other racial and ethnic groups following breast cancer diagnosis persist. Various professional groups have different, somewhat conflicting, guidelines with regards to recommended age for commencing screening as well as recommended frequency of screening exams, but the trials upon which these recommendations are based were not specifically designed to examine benefit among black women. Furthermore, these recommendations do not appear to incorporate the unique epidemiological circumstances of breast cancer among black women, including higher rates of diagnosis before age 40 years and greater likelihood of advanced stage at diagnosis, into their formulation. In this review, we examined the epidemiologic and socioeconomic factors that are associated with breast cancer among black women and assess the implications of these factors for screening in this population. Specifically, we recommend that by no later than age 25 years, all black women should undergo baseline assessment for future risk of breast cancer utilizing a model that incorporates race (e.g., Breast Cancer Risk Assessment Tool [BCRAT], formerly the Gail model) and that this assessment should be conducted by a breast specialist or a healthcare provider (e.g., primary care physician or gynecologist) who is trained to assess breast cancer risk and is aware of the increased risks of early (i.e., premenopausal) and biologically aggressive (e.g., late-stage, triple-negative) breast cancer among black women.

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Author notes

  1. Oluwadamilola M. Fayanju and Christine E. Edmonds are joint First Authors of this article.

Authors and Affiliations

  1. Department of Surgery, Perelman School of Medicine, The University of Pennsylvania, Philadelphia, PA, USA

    Oluwadamilola M. Fayanju MD, MA, MPHS

  2. Rena Rowan Breast Center, Abramson Cancer Center, The University of Pennsylvania, Philadelphia, PA, USA

    Oluwadamilola M. Fayanju MD, MA, MPHS & Christine E. Edmonds MD

  3. Penn Center for Cancer Care Innovation (PC3I), Abramson Cancer Center, The University of Pennsylvania, Philadelphia, PA, USA

    Oluwadamilola M. Fayanju MD, MA, MPHS

  4. Leonard Davis Institute of Health Economics (LDI), The University of Pennsylvania, Philadelphia, PA, USA

    Oluwadamilola M. Fayanju MD, MA, MPHS

  5. Department of Radiology, Perelman School of Medicine, The University of Pennsylvania, Philadelphia, PA, USA

    Christine E. Edmonds MD

  6. Department of Surgery, Donald and Barbara Zucker School of Medicine, Hofstra/Northwell, New Hyde Park, NY, USA

    Sylvia A. Reyes MD

  7. Northwell Health Cancer Institute, New Hyde Park, NY, USA

    Sylvia A. Reyes MD

  8. Katz Institute for Women’s Health, Northwell Health, New Hyde Park, NY, USA

    Sylvia A. Reyes MD

  9. Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA

    Cletus Arciero MD, MS

  10. Department of Surgery, New York-Presbyterian, Brooklyn Methodist, Brooklyn, NY, USA

    Vivian J. Bea MD

  11. Breast Surgery, True Family Women’s Cancer Center, Swedish Cancer Institute, Seattle, WA, USA

    Angelena Crown MD

  12. Department of Surgery, NYU Grossman School of Medicine, New York, NY, USA

    Kathie-Ann Joseph MD, MPH

  13. NYU Langone Health’s Institute for Excellence in Health Equity, New York, NY, USA

    Kathie-Ann Joseph MD, MPH

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Dr. Fayanju is supported by the National Institutes of Health (NIH) under Award Number 7K08CA241390-03 (PI: Fayanju). The content of this manuscript is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. None of the other authors has any conflicts of interest to disclose. The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

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Fayanju, O.M., Edmonds, C.E., Reyes, S.A. et al. The Landmark Series—Addressing Disparities in Breast Cancer Screening: New Recommendations for Black Women. Ann Surg Oncol 30, 58–67 (2023). https://doi.org/10.1245/s10434-022-12535-8

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