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Breast cancer age profile younger in non-white women

Age-based screening guidelines that ignore race might lead to underdiagnosis in non-white women

Louise Prime

Thursday, 08 March 2018

A higher proportion of non-white women with breast cancer were diagnosed before the age of 50 compared with white women, US research has found. The authors of the study*, published in JAMA Surgery, warn that this means that single age-based screening guidelines for breast cancer that do not account for race might result in underdiagnosis of breast cancer in non-white women.

In the UK, all women aged 50-70 and registered with a GP are automatically invited to breast screening every three years; the NHS is currently running a trial of an extension to this age range, offering screening to some women aged 47-73 years. Women at higher-than-average risk of developing breast cancer might be eligible for screening before the age of 50. In the US, the US Preventive Services Task Force (USPSTF) also recommends initiating breast cancer screening at 50 years of age, in patients at average risk.

The authors of this new study, led from Harvard Medical School in Boston, pointed out that the USPSTF guidelines and scientific findings derive largely from data from white populations, and they set out to find out whether they might be generalisable to non-white women.

They analysed data covering 747,763 women with breast cancer who had been included in the Surveillance, Epidemiology, and End Results (SEER) Program database from 1973-2010. They compared age at breast cancer diagnosis in different racial groups, as well as the cancer stage at diagnosis.

They reported that a higher proportion of non-white patients were diagnosed at younger than 50 years of age, compared with white patients. In addition, a higher proportion of black and Hispanic women presented with advanced disease (46.6% and 42.9% respectively), compared with white or Asian women (37.1% and 35.6%).

Median age at diagnosis was 59 years for white women, 56 years for both black and Asian women, and 55 years for Hispanic women. The researchers commented: “We found two distinct distribution patterns of age at diagnosis for female breast cancers: white patients peak in their 60s, whereas non-white patients peak in their 40s...Our finding challenges established norms with regard to screening practices.”

The authors noted that their study was observational, and they might not have been able to control adequately for natural differences that could explain their findings. Nevertheless, they concluded: “Age-based screening guidelines that do not account for race may adversely affect non-white populations. Lowering the breast cancer screening age for non-white groups in the United States should be considered.”

*Stapleton SM, Oseni TO, Bababekov YJ, et al. Race/ethnicity and age distribution of breast cancer diagnosis in the United States. JAMA Surg. Published online March 07, 2018. doi:10.1001/jamasurg.2018.0035.

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