Racial differences in age at breast cancer diagnosis challenges use of single age-based screening guidelines

Bottom Line: Among women in the U.S. diagnosed with breast cancer, a higher proportion of nonwhite patients were diagnosed at younger than 50 years of age compared to white patients, suggesting that age-based screening guidelines that do not account for race may result in underscreening of nonwhite women.

Why The Research Is Interesting: The U.S. Preventive Services Task Force (USPSTF) currently recommends initiating breast cancer screening at 50 years of age in patients at average risk. However, practice guidelines and scientific findings based largely on data from white populations may not be generalizable to other populations.

Who and When: 747,763 women with breast cancer included in the Surveillance, Epidemiology, and End Results (SEER) Program database from 1973-2010.

What (Study Measures): Age and stage at breast cancer diagnosis across racial groups.

How (Study Design): This was an observational study. Researchers were not intervening for purposes of the study and cannot control all the natural differences that could explain the study findings.

Authors: David C. Chang, Ph.D., M.B.A., M.P.H., Massachusetts General Hospital, Harvard Medical School, Boston, and coauthors

In addition, a higher proportion of black and Hispanic patients presented with advanced disease than did white or Asian patients.

Study Limitation: Despite being the largest cancer database in the United States, SEER still does not capture 100 percent of the U.S. population.

Study Conclusions: Age-based screening guidelines that do not account for race may adversely affect nonwhite populations. Lowering the breast cancer screening age for nonwhite groups in the United States should be considered.

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(doi:10.1001/jamasurg.2018.0035)

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