In April, the United States Preventive Services Task Force proposed new breast-cancer screening guidelines that advise women to get their first mammogram, the test that screens for breast cancer, at age 50 and then once every two years thereafter.
These recommendations are at odds with long-standing advice from organizations like the American Cancer Society, the American College of Obstetricians and Gynecologists, the Black Women’s Health Imperative and the Susan G. Komen organization—all of which recommend that women at average risk obtain their first mammogram at 40, followed by one mammogram each year afterward.
The task force recommends that 40-something women discuss their need for mammograms with their doctor. But many experts believe that waiting until 50 for a mammogram is dangerous.
“The recommendations may cause women under 50 to delay paying attention to their breast health and breast-cancer risk,” said Komen President and CEO Dr. Judith A. Salerno in a press release.
“Anytime scientists can’t or don’t agree, it gives some men and women an excuse not to do something that could very well save their lives,” says Linda Goler Blount, president and CEO of the Black Women’s Health Imperative, a Washington, D.C.-based health-advocacy organization. “As a very good friend said, ‘If the scientists can’t agree on when I should have a mammogram, then why should I have a mammogram?’”
Troublesome Advice for Younger Black Women
Early detection of breast cancer saves lives among all women, but particularly black women, who are 10 percent less likely to develop breast cancer than white women but 40 percent more likely to die of it, in part because black women are 45 percent less likely to have health insurance, plus are less likely to be diagnosed early, when more treatment choices exist and they are more effective.
Black women are also more likely to develop a very aggressive strain, triple-negative breast cancer, at a young age. “Younger black women get breast cancer at higher rates and five to seven years younger than white women,” says Blount. For example, it’s not uncommon for black women to develop breast cancer in their 30s.
Half of black women (pdf) are diagnosed before age 57 and half after, compared with age 62 for white women.
Because the task force advises the government, many health advocates—including breast-cancer survivor Rep. Debbie Wasserman Schultz of Florida, who found a lump in her breast at age 41—fear that if its guidelines take hold, health insurers may not cover the full cost of mammograms for women under 50.
Stressed vs. Dead
Experts try to balance the benefits of tests with the harm the tests may cause. For example, mammograms that yield a false-positive result can stress women out and lead to breast biopsies and other unnecessary tests that can be painful and even jeopardize their lives.
Roughly half of women will receive a false-positive result after 10 annual mammograms; fewer than 1 in 10 women who are called back will have breast cancer. Task force Vice Chair Dr. Kristen Bibbins-Domingo wrote in the Washington Post that the task force found that the best balance between benefit and harm existed beginning at age 50.
But let’s be serious: Most women would rather be stressed out for a few weeks than dead.
Blount questions whether the research the task force evaluated is even relevant to black women, noting that the evaluated studies were performed primarily in Sweden and Canada, which do not have large populations of black women.
“Even assuming that the studies were all very well designed and executed, there are no black women in those studies,” says Blount. “So we can’t say [that the task force analysis] applies to women who have a very different lived experience than Swedish and Canadian women. We don’t have any random control trials of mammography on black women. There are [a] few black women in the U.S. studies, but not many.”
The “lived experience” of African-American women includes experience of both racism and sexism and, often, poverty, toxic levels of stress, neighborhoods with high rates of environmental toxins and so on. “If you look at those factors alone, then take studies that were done 30 to 40 years ago in Sweden and Canada and apply it to black women today—it doesn’t make sense,” says Blount.
How to Protect Your Breasts From Breast Cancer
In addition to a no-cost, annual well-woman preventive-care exam, where your health care provider will give you a clinical breast exam beginning at age 20, the Affordable Care Act covers the entire cost of a mammogram, including any deductible and copay. Discuss your risk of breast cancer with your health care provider and follow the advice you are given. If you have a family history of breast cancer or are otherwise at high risk, you may want to consider getting your first mammogram prior to age 40. And particularly if your breast tissue is dense, as is many black women’s, ask your health care provider whether 3-D mammography could be right for you.
If your risk of breast cancer is average, stick to the advice offered by the American Cancer Society, the American College of Obstetricians and Gynecologists, the Black Women’s Health Imperative and the Komen organization: Get your first mammogram by age 40, followed by one per year thereafter.
Obtain your mammogram at a high-volume mammography center, where the doctors who read mammograms have a lot of experience—typically a large hospital—or at a Food and Drug Administration-certified mammography center. Go here to find an FDA-certified mammography site near you.
Conduct a breast self-examination at the same time each month. They do not help women detect cancer early or survive longer if it exists, but they do help women become familiar with the feel of their breasts, so they can notify their doctor immediately if any changes occur.
Philadelphia-based writer Hilary Beard is co-author of Promises Kept: Raising Black Boys to Succeed in School and in Life and Health First! The Black Woman’s Wellness Guide, both of which have won an NAACP Image Award. Follow her on Twitter and Facebook.