Black women and young women most affected by new breast cancer guidelines

The Black Women's Health Imperative, a health advocacy group, has called the new recommendations for delaying the start of mammograms until age 50 a death sentence to black women. The U.S. Preventive Services Task Force (USPSTF), published a report this month detailing new recommendations for breast cancer. In its assessment the taskforce found insufficient evidence to support previous recommendations, made by the same body, that advised women to have biannual mammograms at 40. USPSTF also recommends against teaching breast self-examination.

A press release from the Black Women's Health Imperative said:

"Three facts about breast cancer and Black women make the task force's recommendations inappropriate and potentially deadly. Black women: tend to be diagnosed with breast cancer at a younger age; are more likely to be diagnosed with triple negative breast cancer, a more virulent form; and are more likely to die of breast cancer than White women."

Triple negative breast cancer is mostly diagnosed in younger women, African American and Hispanic women. Most critical to note is that this type of cancer is very aggressive and less responsive to standard breast cancer treatment. Because there have been few studies done on this kind of cancer, oncologists do not know why these particular groups of women are so disproportionally affected. Eleanor Hinton Hoytt, president of the Black Women's Health Imperative, posits that:

[H]istorically, researchers have not studied Black women. Black women have not been at the forefront of the breast cancer movement, and our unique health experiences and outcomes have not been factored into policy and advocacy decisions. These recommendations completely ignore the impact of well-known breast cancer disparities affecting us. ...

I strongly disagree with the notion that preventing the psychological harms and inconvenience caused by false-positive screening results, as implied in the recommendations, outweigh the importance of saving one woman's life. We should not be in the business of rationing care.

According to the National Cancer Institute's Snapshot of Breast Cancer, the incidence of breast cancer is highest in whites, but African Americans have higher mortality rates. In fact, AfricanAmericans have higher mortality rates from breast cancer than any other racial or ethnic group, and the gap is widening.

In a telephone interview, Dr. Regina Hampton, a breast surgeon in Washington DC, said she is shocked and angered by the recommendation that mammograms are unnecessary for women until they are 50.

"These guidelines don't make sense," said Dr. Hampton. "When detected early, breast cancer has pretty high survival rates." Advocacy and health care groups including the National Breast Cancer Foundation report that if detected early, the five-year survival rate exceeds 95%.

Hampton argued that early detection saves both lives and money. "The cost of treating a patient at stage 1 is definitely lower than treating her later when the cancer is full-blown."

In its 2009 annual cancer report, the American Cancer Society attributes the steady decline in breast cancer mortality to early detection thus encouraging both breast self-examination and mammograms in all women. The American Cancer Society report also shows more than a 10 percent difference in breast cancer survival rates between black women and white women.

There is concern that insurance companies could begin using USTPF's recommendations to deny coverage for younger women.

Secretary of Health and Human Services Kathleen Sebelius said in a November 18 statement:

The U.S. Preventive Task Force is an outside independent panel of doctors and scientists who make recommendations. They do not set federal policy and they don't determine what services are covered by the federal government. ...

There has been debate in this country for years about the age at which routine screening mammograms should begin, and how often they should be given. The Task Force has presented some new evidence for consideration but our policies remain unchanged. Indeed, I would be very surprised if any private insurance company changed its mammography coverage decisions as a result of this action. ...

My message to women is simple. Mammograms have always been an important life-saving tool in the fight against breast cancer and they still are today. Keep doing what you have been doing for years -- talk to your doctor about your individual history, ask questions, and make the decision that is right for you.

Nekessa Opoti

Nekessa Opoti (nekessa@tcdailyplanet.net) is a Minneapolis based writer.