Murray Rebner, M.D., performing a breast ultrasound. Image courtesy of Beaumont Health
November 2, 2020 — Though Black women get breast cancer at a 3% lower incidence rate than white women, they are 42% more likely to die of breast cancer than white women. Wait a minute! That doesn’t make sense. Isn’t the death rate from breast cancer on a downward trend?
“We were astounded by this huge difference. The Black Lives Matter movement and equality marches inspired our research to provide better care for African American women,” said Murray Rebner, M.D., a Beaumont diagnostic radiologist who specializes in breast imaging. “My research partner, Vidya Pai, M.D., and I started to look deeply into the data to find out the reasons for this disturbing racial disparity to see if we could do anything that could save more lives of African American women.”
The physicians focused on how Black women dealt with getting screened and unique issues relevant to them. They revealed their findings recently in the Journal of Breast Imaging. Facts from “Breast Cancer Screening Recommendations: African American Women Are at a Disadvantage” include:
- Black women are more likely than white women to be diagnosed with breast cancer before the age of 50. Studies show 23% of breast cancers in Black women are diagnosed before age 50 compared to 16% of all breast cancers in white women.
- BRCAgenetic mutations are more common in Black women than in white women, although less frequent those of Ashkenazi Jewish ancestry.
- The triple-negative breast cancer subtype is more common among Black women. This subtype is aggressive but can have features that overlap with benign conditions like noncancerous breast lumps.
- Because of the higher incidence of aggressive breast cancer at a younger age, Black women might be disadvantaged by recommendations to start doing screening mammography at age 50.
Earlier breast screening gives Black women the most benefit
Screening guidelines are important because they guide doctors' recommendations and can determine if screening is covered by insurance. Breast cancer screening guidelines that recommend an older age to start screenings disadvantage Black women because they ignore key facts about their heightened risk at younger ages.
Rebner explained, “What’s even more concerning is African American women are much more likely to get a very aggressive triple negative breast cancer, which grows and spreads faster, has limited treatment options and a worse outcome. Triple negative breast cancer makes up 21% of the cases in African American women compared to 10% in white women.”
Rebner continued, “Fact one is earlier onset. Fact two is a more aggressive cancer type. Therefore, Dr. Pai and I conclude African American women need to be screened earlier, starting at least by age 40, and need to be screened yearly.”
“If African American women’s lives are to be saved, these aggressive breast cancers must be diagnosed and treated early,” said Rebner. “Heightening their risk is the BRCA2 genetic mutation, which dramatically raises the risk of breast cancer and is more common in African American women compared to non-Ashkenazi Jewish white women.”
Black women: Push for earlier screening
“Dr. Pai and I urge all women to take responsibility for their own health. Be aware of your own risks and feel empowered to discuss your risk of breast cancer and when and how often to get screened with your doctor,” advised Rebner.
But, what if you don’t have a doctor? It’s important for any woman to establish a relationship with a primary care doctor, who meets your needs and with whom you feel comfortable sharing very personal information. This could be a family medicine physician, gynecologist or internal medicine physician. Help finding a primary care doctor may be found here.
While it’s never too early for women to take a self-guided health risk assessment. Rebner recommends doing this by age 30, if you’re on the young side, or at any age if you’re older than 30. Click here for Beaumont’s free breast cancer risk assessment tool.
For more information: www.beaumont.org