Last week, the U.S. Preventive Services Task Force (USPSTF)—a panel of experts that issues guidelines about preventative care—posted a draft recommendation that all women start bi-annual (every other year) routine breast cancer screening at 40 years old. This is a ten-year jump from the task force’s previous recommendation of starting breast screening at 50.
“I think it’s a small step in the right direction after a huge step in the WRONG direction,” says Dr. Monique Gary, DO, MSc, FACS—Medical Director at Grand View Health/ Penn Cancer Network. “When their last recommendations were released in 2016, it did more harm than good in a few ways. Besides recommending against self-breast exams, it spurred all these studies… spending valuable resources to prove harm of screening guidelines for Black women. In my opinion, it was tragic, when it is quite evident that delays in screening are one of the many forces at play in our presentation of more advanced disease.“
Many responses to this recent recommendation have overlooked a critical detail—it only applies to all people assigned female at birth who are at average risk for breast cancer. This guidance does NOT apply to women with dense breasts, Black women, or women with a family history of breast cancer. Black women, we are not at average risk!
The disturbing facts*
Black women under 35 get breast cancer at twice the rate of white women and die at three times the rate. Black women ages 40-49 are 80% more likely to die of breast cancer than white women. Black women are three times more likely than white women to be diagnosed with triple-negative breast cancer—a particularly aggressive subtype of breast cancer associated with worse outcomes, early relapse, high frequency of metastasis, and high mortality rate—and have the lowest survival rate at each stage of diagnosis.
Triple-negative breast cancer is more common in young women, and those diagnosed with breast cancer under the age of 40 are twice as likely to have TNBC than those between the ages of 50 and 64. Women who are diagnosed with TNBC are 53% more likely to be under 40 years old. TNBC disproportionately occurs in younger Black women who are more likely to have poorer prognostic features than older patients upon diagnosis.
More than that, though, women with extremely dense breasts have a four to six times greater risk of developing breast cancer than women with mostly fatty breasts. Black women have statistically significantly higher (21.1%) absolute breast area density than white women. Black women also have statistically significantly (44.9%) higher volumetric density than white women. You don’t know whether you have dense breasts until you have had a mammogram.
Clearly, waiting to get our first mammograms at age 40 is way too late for Black women.
Black Women, so what does this mean for us?
As both a triple-negative breast cancer survivor and the CEO and co-founder of TOUCH, The Black Breast Cancer Alliance (TOUCHBBCA), I read the updated task force recommendations with growing anger and concern for our young Black women, especially my own daughters. My family is currently fighting with our health insurance companies to cover the cost of mammograms for my daughters because we have three generations of breast cancer in our family HERstory.
To understand the scientific perspective outside of my own intense maternal reaction, I reached out to the brilliant TOUCHBBCA medical advisory board. Their overall thoughtful perspective was that moving the age of the first mammogram from 50 to 40 was a significant and long overdue first step for average women. But, once again, Black women are not average!
Black women, so what can we do to protect themselves?
Black Breast Cancer is a different disease and, in the same vein, Black Breast Health looks different for Black women. Too often young, Black women unaware of their risk are dismissed by doctors and end up with