Tuesday, November 17, 2009

Dear USPSTF: What About Mammograms for Black Women?

In the news yesterday, and today discussed on Twitter, is a U.S. Preventive Services Task Force publicized report that women don't need mammograms in their 40s as previously thought. Does this task force have the last word, and what does this mean for black women who tend to get aggressive forms of breast cancer?

Contemplating the USPSTF report, I thought about the American Cancer Society's outreach campaign, More Birthdays, declaring the ACS the "Official Sponsor of Birthdays," and I wondered what the ACS's take is on this task force report. Then I decided to post the American Cancer Society's video, which was released in May.

The video reminds us of the good work done by the ACS over the years, its many contributions to cancer research and education. The USPSTF's guidelines, however, are at odds with the ACS's long-trusted guidelines on mammograms and early detection of cancer.

As a black female, I'm not sure what to make of the USPSTF's stance. I wonder did that government task force factor into its study that breast cancer may strike black women differently than it does white women. While black women are less likely to get breast cancer than white women, when they do get it, black women are more likely to die from breast cancer than white women. Black women tend to develop a more aggressive form of cancer.
Young black women with breast cancer are more prone than whites or older blacks to develop a type of tumor with genetic traits that make it especially deadly and hard to treat, a study has found.

Among premenopausal black women with breast cancer, 39 percent had the more dangerous kind, called a "basal like" subtype, compared with only 14 percent of older black women and 16 percent of nonblack women of any age. Researchers are not sure why.

The study, being published today (June 7, 2006) in The Journal of the American Medical Association, is the first to measure how common the different genetic subtypes of breast tumors are in American women, and to sort the subtypes by race. The authors said more research was needed to test their conclusions. (New York Times, 2006)
The ACS published similar information in 2000, six years earlier than the date of the NYT article. In addition, black women have less access to good medical care before and after developing breast cancer. (Hear NPR story.)

So, while I'm not a doctor and I'm not saying that the USPSTF study has overlooked black women, I'm still thinking the last thing an African-American woman should do is put off an early-detection test or not take advantage as soon as she can of any preventive service that may prolong her life, give her more birthdays. This of course assumes she has access to health care or is served by a health insurance company that won't drop her because she may be high risk.

My particular concern as a black female aside, the American Cancer Society's guidelines are more cautious for everyone. Writing at his blog, one ACS doctor says:
The United States Preventivec Services Task Force (USPSTF) today released a series of reports updating their guideline recommendations for screening mammography for the early detection of breast cancer. Their conclusions are bound to raise another round of intense discussion about the benefits, risks and harms of screening for breast cancer.

There is certainly nothing wrong with that, with the exception that if we make the wrong decisions or offer women the wrong guidance about the early detection of breast cancer, we could reverse the considerable progress that has been make in reducing deaths from this disease over the past twenty years.

Unlike the Task Force, the American Cancer Society is not changing its current recommendations that women at average risk of getting breast cancer should get a mammogram every year starting at age 40.

In this era of health care reform, these new Task Force guidelines could have real implications for how insurers, government programs and maybe even the pending health care reform bills will cover screening mammography in the future.

Before I actually discuss the guidelines, I would like to set the stage with the very last sentence of the report that came from one of the evidence reports written by researchers from the Oregon University Health Sciences Center (OHSU). I do this because I think it puts the issue into context:

“Mammography screening at any age is a tradeoff of a continuum of benefits and harms. The ages at which this tradeoff becomes acceptable to individuals and society are not clearly resolved by the available evidence.” (emphasis mine)

With that as a starting point, here are the short versions of the Task Force’s new recommendations for screening mammography ...
Read Dr. Len Lichtenfeld's blog post, "Finding Breast Cancer Early: Age 40, Every Year." Also, see this slide show of breast cancer survivors who support mammography; the African-American women are eerily absent, but I'm sure there are some African-American survivors of breast cancer somewhere.


msladyDeborah said...


Did you get the impression that we were a consideration in this latest announcement by USPSTF? I don't think that they gave enough consideration to the situation that African American women face regarding Breast Cancer. I think that the report can and will be challenged. It did not seem to be indepth enough to address my immediate questions and concerns.

I suspect that this is going to cause a major battle between women, insurance companies and groups that have worked on Breast Cancer Support.

I think that for the moment we should continue to get our mammograms like our doctors and family history suggests would be correct.

Sister Big said...

I agree with Ms. Lady Deborah. I'm going to keep getting my mammograms starting at 40 even if I have to sell a pair of shoes to pay for them. Guidelines never work for everyone, and I have a history of cancer in my family.

Get the mammograms!


Hi Nordette,

Black women ABSOLUTELY need to get mammograms every single year and never miss one!!

It bothers me so much that we are the main group that is diagnosed at "end stage" and the main group that dies from breast cancer when we could have lived if we had been diagnosed earlier.

We really need to tell more black women to get their mammograms!

Peace, blessings and DUNAMIS!

Kate Burton said...


I am so sorry that anyone led you to believe that women's health was something that was even considered by this group.

62,000 women under age 50 were diagnosed with breast cancer in 2003 (I can't seem to get newer data that's reliable)

I was diagnosed at age 38 and am now 42 but that is due to aggressive treatment. I would not have benefitted from mammography in the 40+ category but I know a lot of women who would.

This is about money, plain and simple. Keep going for your mammograms and encourage the women you know to keep going. It's all we have right now.