Posted 06/07/2007

Experts say new guidelines may be in order to screen African-American women for breast cancer

Most medical authorities agree that mammograms are important in detecting early breast cancer and, when coupled with appropriate treatment, can boost the odds of a woman’s survival.   

However, some health experts, including cancer researchers at the University of South Carolina’s Arnold School of Public Health, wonder whether current guidelines calling for annual mammograms are a blanket approach that doesn’t allow for individual and racial differences. 

Drs. James Hébert and Swann Arp Adams weighed in on the guidelines in light of a recent study showing that fewer women are getting yearly tests. 

The percentage of women 40 years of age and older saying they had a mammogram within the past two years slipped from 70 percent in 2000 to 66 percent in 2005. The numbers were reported in a study appearing in Cancer, a scientific journal published by the American Cancer Society.

This is in direct contrast to the big increases seen in the rates since the 1980s. The mammography rate for women past the age of 40 was only 39 percent in 1987. 

Adams, a co-investigator at the S.C. Statewide Cancer Prevention and Control Program and a member of the S.C. Cancer Disparities Community Network, says she’s finishing work on a project based on the observations of radiologists at Columbia’s Palmetto Richland Hospital. 

The radiologists observed that African-American women appear to develop more aggressive cancers during the interval between mammograms, an hypothesis supported by a preliminary analysis of study data. 

“We are still analyzing the data to see if we can determine if  we can further define a certain group of African-American women or a type of breast cancer that is more likely to be an interval cancer,” she said.  

Hébert said of Adams’ study, “It could end up that you may have different screening guidelines for blacks who are more likely to have a nasty interval cancer than for whites.”  

Hébert said that refining the screening guidelines for breast cancer should be investigated. “We do it all the time with other diseases,” he said.  He also noted that the official screening recommendations in Canada and Sweden (both of which have well-organized centrally planned health delivery and data systems) advise beginning screening mammography at an older age and having a longer interval between mammograms. 

Adams says there’s a serious disparity in mortality rates between African-American women and European-American women in South Carolina with African American women dying much faster from breast cancer.  This disparity becomes even more significant when the higher incidence of breast cancer among European-American women is considered. 

In a study published last summer in the Journal of the S.C. Medical Association, Adams reported that data already indicates African-American women are about 42 percent more likely than European-American women to die of breast cancer once they have a diagnosis of the disease; one of the largest such disparity in the U.S. 

Adams’ report in the JSCMA also noted that mammography is not the only valid screening method for breast cancer. Clinical and breast self-examination, MRI scans and tissue sampling also may be used. 

“Because detection rate may depend on age, ethnicity, and breast mammographic characteristics, women for whom regular screening methods do not detect their cancers (I.E. age, ethnicity, dense breasts) must be identified and other screening methods promoted within those populations,” Adams said in the Journal article.