Skip to main content
PMC home page
Journal of the National Medical Association logoLink to Journal of the National Medical Association
. 2002 Mar;94(3):149–156.

Breast cancer racial differences before age 40--implications for screening.

Edwin T Johnson 1
PMCID: PMC2594112  PMID: 11918384

Abstract

BACKGROUND: Most authorities advocate mammogram screening for breast cancer beginning at age 40 based on the age-specific distribution and incidence of breast cancer in the general population. This policy has been bolstered by studies that demonstrate that, for the general population, mammography in the 40-49 age bracket reduces mortality. However, it also has been reported that African-American breast cancer patients are diagnosed more often than white patients below the age of 40. Young African-American women are also more likely to have advanced disease at the time of diagnosis with predictably higher mortality. The purpose of this investigation is to explore the question, whether a subset of African-American women, age 30-39, by virtue of increased vulnerability, would benefit from early mammogram screening. STUDY DESIGN: The age-specific distribution (age 30-84) of African-American and white breast cancer patients in five State cancer registries were compared. Prognostic indicators (tumor size and nodal status) in two of the five registries in African-American and white breast cancer cases below the age of 40 were compared. Age-specific incidence in the 30-39 age group and the relative populations of black and white women in the United States were noted in the Surveillance Epidemiology and End Report (SEER) (1994-1998) and The U.S. Census 2000. RESULTS: The differences of age-specific distribution and age-specific incidence of African-American and white breast cancer patients were found to be significant. More than 10% of African-American women with breast cancer were diagnosed before age 40 compared to 5% of white patients. The incidence of breast cancer (SEER Report 1994-1998) in the 30-39-age bracket for African-American and white women was 48.9 and 40.2 at the 95% confidence level, while the proportion of African-American and white women reported by the Census Bureau was not too dissimilar, 15.8% and 14.6% respectively. Prognostic indicators (tumor size and nodal status) support the notion that young African-American women are more likely to have advanced disease at diagnosis. CONCLUSIONS: African-American women in the 30-39 age group have twice the age-specific distribution, have a higher incidence compared to their white counterparts, and exhibit more ominous prognostic signs. This study provides evidence that African-American women in the 30-39 age category represent a high-risk group that may benefit from efforts at earlier detection. Although mammography remains the preferred screening modality, investigators have pointed out difficulties encountered when using mammography in young women, including low sensitivity, high breast density, cost/benefit concerns, and low positive predictive value. Nevertheless, the increasing mortality and persistent racial incidence gap in young African-American women, age 30-39, argue for considering early screening mammography in spite of recognized concerns.

Full text

PDF
149

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Aziz H., Hussain F., Sohn C., Mediavillo R., Saitta A., Hussain A., Brandys M., Homel P., Rotman M. Early onset of breast carcinoma in African American women with poor prognostic factors. Am J Clin Oncol. 1999 Oct;22(5):436–440. doi: 10.1097/00000421-199910000-00002. [DOI] [PubMed] [Google Scholar]
  2. Butler J. R., Furnival C. M., Hart R. F. The costs of treating breast cancer in Australia and the implications for breast cancer screening. Aust N Z J Surg. 1995 Jul;65(7):485–491. doi: 10.1111/j.1445-2197.1995.tb01791.x. [DOI] [PubMed] [Google Scholar]
  3. Caplan L. S., Helzlsouer K. J., Shapiro S., Wesley M. N., Edwards B. K. Reasons for delay in breast cancer diagnosis. Prev Med. 1996 Mar-Apr;25(2):218–224. doi: 10.1006/pmed.1996.0049. [DOI] [PubMed] [Google Scholar]
  4. Cowan W. K., Kelly P., Sawan A., Cunliffe W. J., Henry L., Higgs M. J., Lunt L. G., Young J. R., Horne C. H., Angus B. The pathological and biological nature of screen-detected breast carcinomas: a morphological and immunohistochemical study. J Pathol. 1997 May;182(1):29–35. doi: 10.1002/(SICI)1096-9896(199705)182:1<29::AID-PATH820>3.0.CO;2-#. [DOI] [PubMed] [Google Scholar]
  5. Dodd G. D. American Cancer Society guidelines on screening for breast cancer. An overview. Cancer. 1992 Apr 1;69(7 Suppl):1885–1887. doi: 10.1002/1097-0142(19920401)69:7+<1885::aid-cncr2820691702>3.0.co;2-b. [DOI] [PubMed] [Google Scholar]
  6. Eley J. W., Hill H. A., Chen V. W., Austin D. F., Wesley M. N., Muss H. B., Greenberg R. S., Coates R. J., Correa P., Redmond C. K. Racial differences in survival from breast cancer. Results of the National Cancer Institute Black/White Cancer Survival Study. JAMA. 1994 Sep 28;272(12):947–954. doi: 10.1001/jama.272.12.947. [DOI] [PubMed] [Google Scholar]
  7. Foster R. S., Jr, Worden J. K., Costanza M. C., Solomon L. J. Clinical breast examination and breast self-examination. Past and present effect on breast cancer survival. Cancer. 1992 Apr 1;69(7 Suppl):1992–1998. doi: 10.1002/1097-0142(19920401)69:7+<1992::aid-cncr2820691721>3.0.co;2-h. [DOI] [PubMed] [Google Scholar]
  8. Gray G. E., Henderson B. E., Pike M. C. Changing ratio of breast cancer incidence rates with age of black females compared with white females in the United States. J Natl Cancer Inst. 1980 Mar;64(3):461–463. [PubMed] [Google Scholar]
  9. Hunter C. P., Redmond C. K., Chen V. W., Austin D. F., Greenberg R. S., Correa P., Muss H. B., Forman M. R., Wesley M. N., Blacklow R. S. Breast cancer: factors associated with stage at diagnosis in black and white women. Black/White Cancer Survival Study Group. J Natl Cancer Inst. 1993 Jul 21;85(14):1129–1137. doi: 10.1093/jnci/85.14.1129. [DOI] [PubMed] [Google Scholar]
  10. Joslyn S. A., West M. M. Racial differences in breast carcinoma survival. Cancer. 2000 Jan 1;88(1):114–123. doi: 10.1002/(sici)1097-0142(20000101)88:1<114::aid-cncr16>3.0.co;2-j. [DOI] [PubMed] [Google Scholar]
  11. Kerlikowske K., Grady D., Barclay J., Sickles E. A., Ernster V. Effect of age, breast density, and family history on the sensitivity of first screening mammography. JAMA. 1996 Jul 3;276(1):33–38. [PubMed] [Google Scholar]
  12. Kopans D. B., Feig S. A. The Canadian National Breast Screening Study: a critical review. AJR Am J Roentgenol. 1993 Oct;161(4):755–760. doi: 10.2214/ajr.161.4.8372752. [DOI] [PubMed] [Google Scholar]
  13. Laing A. E., Demenais F. M., Williams R., Kissling G., Chen V. W., Bonney G. E. Breast cancer risk factors in African-American women: the Howard University Tumor Registry experience. J Natl Med Assoc. 1993 Dec;85(12):931–939. [PMC free article] [PubMed] [Google Scholar]
  14. Lannin D. R., Mathews H. F., Mitchell J., Swanson M. S., Swanson F. H., Edwards M. S. Influence of socioeconomic and cultural factors on racial differences in late-stage presentation of breast cancer. JAMA. 1998 Jun 10;279(22):1801–1807. doi: 10.1001/jama.279.22.1801. [DOI] [PubMed] [Google Scholar]
  15. Lyman G. H., Kuderer N. M., Lyman S. L., Cox C. E., Reintgen D., Baekey P. Importance of race on breast cancer survival. Ann Surg Oncol. 1997 Jan;4(1):80–87. doi: 10.1007/BF02316814. [DOI] [PubMed] [Google Scholar]
  16. Mandelblatt J., Andrews H., Kao R., Wallace R., Kerner J. Impact of access and social context on breast cancer stage at diagnosis. J Health Care Poor Underserved. 1995;6(3):342–351. doi: 10.1353/hpu.2010.0449. [DOI] [PubMed] [Google Scholar]
  17. McPherson C. P., Swenson K. K., Jolitz G., Murray C. L. Survival of women ages 40-49 years with breast carcinoma according to method of detection. Cancer. 1997 May 15;79(10):1923–1932. doi: 10.1002/(sici)1097-0142(19970515)79:10<1923::aid-cncr13>3.0.co;2-x. [DOI] [PubMed] [Google Scholar]
  18. Natarajan N., Nemoto T., Mettlin C., Murphy G. P. Race-related differences in breast cancer patients. Results of the 1982 national survey of breast cancer by the American College of Surgeons. Cancer. 1985 Oct 1;56(7):1704–1709. doi: 10.1002/1097-0142(19851001)56:7<1704::aid-cncr2820560740>3.0.co;2-l. [DOI] [PubMed] [Google Scholar]
  19. Newman L. A., Alfonso A. E. Age-related differences in breast cancer stage at diagnosis between black and white patients in an urban community hospital. Ann Surg Oncol. 1997 Dec;4(8):655–662. doi: 10.1007/BF02303751. [DOI] [PubMed] [Google Scholar]
  20. O'Malley M. S., Fletcher S. W. US Preventive Services Task Force. Screening for breast cancer with breast self-examination. A critical review. JAMA. 1987 Apr 24;257(16):2196–2203. [PubMed] [Google Scholar]
  21. Pierce L., Fowble B., Solin L. J., Schultz D. J., Rosser C., Goodman R. L. Conservative surgery and radiation therapy in black women with early stage breast cancer. Patterns of failure and analysis of outcome. Cancer. 1992 Jun 1;69(11):2831–2841. doi: 10.1002/1097-0142(19920601)69:11<2831::aid-cncr2820691132>3.0.co;2-j. [DOI] [PubMed] [Google Scholar]
  22. Robinson R. G., Kessler L. G., Naughton M. D. Cancer awareness among African Americans: a survey assessing race, social status, and occupation. J Natl Med Assoc. 1991 Jun;83(6):491–497. [PMC free article] [PubMed] [Google Scholar]
  23. Sickles E. A., Ominsky S. H., Sollitto R. A., Galvin H. B., Monticciolo D. L. Medical audit of a rapid-throughput mammography screening practice: methodology and results of 27,114 examinations. Radiology. 1990 May;175(2):323–327. doi: 10.1148/radiology.175.2.2326455. [DOI] [PubMed] [Google Scholar]
  24. Smart C. R., Hartmann W. H., Beahrs O. H., Garfinkel L. Insights into breast cancer screening of younger women. Evidence from the 14-year follow-up of the Breast Cancer Detection Demonstration Project. Cancer. 1993 Aug 15;72(4 Suppl):1449–1456. doi: 10.1002/1097-0142(19930815)72:4+<1449::aid-cncr2820721406>3.0.co;2-c. [DOI] [PubMed] [Google Scholar]
  25. Tabàr L., Fagerberg G., Duffy S. W., Day N. E., Gad A., Gröntoft O. Update of the Swedish two-county program of mammographic screening for breast cancer. Radiol Clin North Am. 1992 Jan;30(1):187–210. [PubMed] [Google Scholar]
  26. Trock B. J. Breast cancer in African American women: epidemiology and tumor biology. Breast Cancer Res Treat. 1996;40(1):11–24. doi: 10.1007/BF01805999. [DOI] [PubMed] [Google Scholar]
  27. Young J. L., Jr, Ries L. G., Pollack E. S. Cancer patient survival among ethnic groups in the United States. J Natl Cancer Inst. 1984 Aug;73(2):341–352. doi: 10.1093/jnci/73.2.341. [DOI] [PubMed] [Google Scholar]

Articles from Journal of the National Medical Association are provided here courtesy of National Medical Association

RESOURCES