Breast cancer: Screening from age 50 puts racialized women at a disadvantage

There is an urgent need to re-evaluate breast cancer screening guidelines to include racial and ethnic disparities, warns a recent University of Ottawa study published in the Oncologist. According to the researchers, Canadian women who don't identify themselves as white have an earlier peak age for breast cancer diagnosis and a higher proportion of cases diagnosed before the age of 50. They also have an earlier mortality peak, dying on average seven years earlier than white women. Black women are also more likely to develop aggressive triple-negative breast cancer.As Canada does not currently document the particularities and outcomes of breast cancer by race and ethnicity, the researchers cross-referenced data from the 2006 and 2011 Canadian Census Health and Environment Cohorts, as well as from the Canadian Cancer Registry. In total, they studied 47,000 cases of breast cancer and 18,200 deaths from breast cancer. Research highlightsCompared with a white woman of the same age, a 40-year-old Black woman is 40% more likely to die of breast cancer.Mortality rates among 60-year-olds from First Nations and Métis communities are 20% to 50% higher, respectively, than among white women in the same age bracket.The peak age at diagnosis of breast cancer was 65 for white women, compared with 42 to 60 for women of other racial or ethnic origins.The median age at diagnosis of breast cancer among Black women (56 years) in Canada was comparable to, and even lower than, that observed in the U.S. (60 years), and the median age at diagnosis among white Canadian women was also comparable to that observed in the U.S. (63 and 64 years respectively).Approximately one-third of breast cancers detected before the age of 50 are in Arab, Korean, Inuit, multi-ethnic or West Asian women, compared with 16% in white women.Hormone receptor-positive breast cancers, for which treatment has a better success rate, are more common in white women, while the incidence of triple-negative breast cancer, an aggressive form with a much lower survival rate, is twice as high in Black women (five-year survival rate is 74% at stage 3 and only 7% at stage 4).The differences in mortality observed could be linked to the earlier peak age of diagnosis, meaning that breast cancer cases are diagnosed before screening is available, note the authors. This could explain why almost half of stage 3 or 4 breast cancer cases in Black women were diagnosed before the age of 50, compared with a fifth of stage 3 or 4 cases in white women.The research team, led by Dr. Anna Wilkinson, a family physician, and Dr. Jean Seely, a professor in the department of radiology at the University of Ottawa, along with Statistics Canada researchers, is therefore calling for an urgent revision of screening guidelines to include screening as early as age 40. “Starting screening programs at age 50 systematically disadvantages racialized women and women from different ethnic groups. Cancers diagnosed in this way are likely to be at a more advanced stage, which could translate into a higher mortality rate for Black women,” said Dr. Wilkinson, associate professor at the University of Ottawa's faculty of medicine.Provincial progress on screening ageIn Quebec, Health Minister Christian Dubé announced in October that he had mandated the Institut national d'excellence en santé et en services sociaux to evaluate the potential expansion of breast cancer screening to as early as age 40. In addition, Ontario's structured screening program now extends to women aged 40 to 49.The Manitoba government has vowed to progressively lower the age for self-referrals to 40 from 50, beginning with a commitment to get to age 45 by the end of 2025.Despite these provincial advances, national guidelines continue to encourage family physicians to advise their patients against screening. As a result, many cancers may not be detected early in women of colour.Age of diagnosis isn't the only issue, according to the authors: The aim is to decipher the obstacles that women of colour may face at different stages of the disease, from screening to treatment.“Targeted research is essential to better understand the underlying causes of breast cancer mortality disparities affecting Black, First Nations and Métis women,” the authors concluded.

Breast cancer: Screening from age 50 puts racialized women at a disadvantage

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