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Race and Ethnicity-Adjusted Age Recommendation for Initiating Breast Cancer Screening

Chen, Tianhui LU ; Kharazmi, Elham LU and Fallah, Mahdi LU (2023) In JAMA Network Open 6(4).
Abstract

IMPORTANCE: Breast cancer (BC) is the second leading cause of cancer death in women, and there is a substantial disparity in BC mortality by race, especially for early-onset BC in Black women. Many guidelines recommend starting BC screening from age 50 years; however, the current one-size-fits-all policy to start screening all women from a certain age may not be fair, equitable, or optimal.

OBJECTIVE: To provide race and ethnicity-adapted starting ages of BC screening based on data on current racial and ethnic disparities in BC mortality.

DESIGN, SETTING, AND PARTICIPANTS: This nationwide population-based cross-sectional study was conducted using data on BC mortality in female patients in the US who died of BC in 2011 to... (More)

IMPORTANCE: Breast cancer (BC) is the second leading cause of cancer death in women, and there is a substantial disparity in BC mortality by race, especially for early-onset BC in Black women. Many guidelines recommend starting BC screening from age 50 years; however, the current one-size-fits-all policy to start screening all women from a certain age may not be fair, equitable, or optimal.

OBJECTIVE: To provide race and ethnicity-adapted starting ages of BC screening based on data on current racial and ethnic disparities in BC mortality.

DESIGN, SETTING, AND PARTICIPANTS: This nationwide population-based cross-sectional study was conducted using data on BC mortality in female patients in the US who died of BC in 2011 to 2020.

EXPOSURES: Proxy-reported race and ethnicity information was used. The risk-adapted starting age of BC screening by race and ethnicity was measured based on 10-year cumulative risk of BC-specific death. Age-specific 10-year cumulative risk was calculated based on age group-specific mortality data without modeling or adjustment.

MAIN OUTCOMES AND MEASURES: Disease-specific mortality due to invasive BC in female patients.

RESULTS: There were BC-specific deaths among 415 277 female patients (1880 American Indian or Alaska Native [0.5%], 12 086 Asian or Pacific Islander [2.9%], 62 695 Black [15.1%], 28 747 Hispanic [6.9%], and 309 869 White [74.6%]; 115 214 patients died before age 60 years [27.7%]) of any age in the US in 2011 to 2020. BC mortality per 100 000 person-years for ages 40 to 49 years was 27 deaths in Black females, 15 deaths in White females, and 11 deaths in American Indian or Alaska Native, Hispanic, and Asian or Pacific Islander females. When BC screening was recommended to start at age 50 years for all females with a 10-year cumulative risk of BC death of 0.329%, Black females reached this risk threshold level 8 years earlier, at age 42 years, whereas White females reached it at age 51 years, American Indian or Alaska Native and Hispanic females at age 57 years, and Asian or Pacific Islander females 11 years later, at age 61 years. Race and ethnicity-adapted starting ages for Black females were 6 years earlier for mass screening at age 40 years and 7 years earlier for mass screening at age 45 years.

CONCLUSIONS AND RELEVANCE: This study provides evidence-based race-adapted starting ages for BC screening. These findings suggest that health policy makers may consider a risk-adapted approach to BC screening in which individuals who are at high risk are screened earlier to address mortality due to early-onset BC before the recommended age of mass screening.

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author
; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Humans, Female, Middle Aged, Adult, Child, Ethnicity, Breast Neoplasms/diagnosis, Cross-Sectional Studies, Early Detection of Cancer, Hispanic or Latino
in
JAMA Network Open
volume
6
issue
4
article number
e238893
pages
8 pages
publisher
American Medical Association
external identifiers
  • scopus:85153123316
  • pmid:37074714
ISSN
2574-3805
DOI
10.1001/jamanetworkopen.2023.8893
language
English
LU publication?
yes
id
6987b267-3ef6-4c16-9a04-d00b70e6c219
date added to LUP
2023-05-05 12:58:24
date last changed
2024-05-18 23:55:32
@article{6987b267-3ef6-4c16-9a04-d00b70e6c219,
  abstract     = {{<p>IMPORTANCE: Breast cancer (BC) is the second leading cause of cancer death in women, and there is a substantial disparity in BC mortality by race, especially for early-onset BC in Black women. Many guidelines recommend starting BC screening from age 50 years; however, the current one-size-fits-all policy to start screening all women from a certain age may not be fair, equitable, or optimal.</p><p>OBJECTIVE: To provide race and ethnicity-adapted starting ages of BC screening based on data on current racial and ethnic disparities in BC mortality.</p><p>DESIGN, SETTING, AND PARTICIPANTS: This nationwide population-based cross-sectional study was conducted using data on BC mortality in female patients in the US who died of BC in 2011 to 2020.</p><p>EXPOSURES: Proxy-reported race and ethnicity information was used. The risk-adapted starting age of BC screening by race and ethnicity was measured based on 10-year cumulative risk of BC-specific death. Age-specific 10-year cumulative risk was calculated based on age group-specific mortality data without modeling or adjustment.</p><p>MAIN OUTCOMES AND MEASURES: Disease-specific mortality due to invasive BC in female patients.</p><p>RESULTS: There were BC-specific deaths among 415 277 female patients (1880 American Indian or Alaska Native [0.5%], 12 086 Asian or Pacific Islander [2.9%], 62 695 Black [15.1%], 28 747 Hispanic [6.9%], and 309 869 White [74.6%]; 115 214 patients died before age 60 years [27.7%]) of any age in the US in 2011 to 2020. BC mortality per 100 000 person-years for ages 40 to 49 years was 27 deaths in Black females, 15 deaths in White females, and 11 deaths in American Indian or Alaska Native, Hispanic, and Asian or Pacific Islander females. When BC screening was recommended to start at age 50 years for all females with a 10-year cumulative risk of BC death of 0.329%, Black females reached this risk threshold level 8 years earlier, at age 42 years, whereas White females reached it at age 51 years, American Indian or Alaska Native and Hispanic females at age 57 years, and Asian or Pacific Islander females 11 years later, at age 61 years. Race and ethnicity-adapted starting ages for Black females were 6 years earlier for mass screening at age 40 years and 7 years earlier for mass screening at age 45 years.</p><p>CONCLUSIONS AND RELEVANCE: This study provides evidence-based race-adapted starting ages for BC screening. These findings suggest that health policy makers may consider a risk-adapted approach to BC screening in which individuals who are at high risk are screened earlier to address mortality due to early-onset BC before the recommended age of mass screening.</p>}},
  author       = {{Chen, Tianhui and Kharazmi, Elham and Fallah, Mahdi}},
  issn         = {{2574-3805}},
  keywords     = {{Humans; Female; Middle Aged; Adult; Child; Ethnicity; Breast Neoplasms/diagnosis; Cross-Sectional Studies; Early Detection of Cancer; Hispanic or Latino}},
  language     = {{eng}},
  month        = {{04}},
  number       = {{4}},
  publisher    = {{American Medical Association}},
  series       = {{JAMA Network Open}},
  title        = {{Race and Ethnicity-Adjusted Age Recommendation for Initiating Breast Cancer Screening}},
  url          = {{http://dx.doi.org/10.1001/jamanetworkopen.2023.8893}},
  doi          = {{10.1001/jamanetworkopen.2023.8893}},
  volume       = {{6}},
  year         = {{2023}},
}