Breast Cancer Under Forty

For African –American women, breast cancer screening may need to start earlier

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STANDARD

Doriane C. Miller, MD

When we hear the word mammogram, most of us think of a middle-aged woman headed for retirement. But, for some African-Americans, that word needs to start including those of us who are under age 40.

In our 30s and 40s, women are often focused on family and career, but we have to start putting breast cancer on our radar as well—and not just in October during breast cancer awareness month. It’s no longer just a middle-aged woman’s disease.

Most of us know someone who has had breast cancer. Even though white women over age 40 have historically had a higher number of individual cases of breast cancer, African-American women are catching up, according to an October 2013 report from CA: A Cancer Journal for Clinicians.

This could be a sign that more African-American women are being screened for breast cancer. So, more cases are being reported. That’s a good thing. But here’s the bad news: Our death rates from cancer are higher than women of other ethnicities.

When treatment can help the most

One study looked at what happened to more than 7,000 black African-American cancer patients and compared it to the same number of white breast cancer patients. About 69 percent of the white women were still alive five years later. Only 56 percent of the black women were still alive.

The problem is that black women are not getting treatment early enough, said the lead author of the study in a CBS News Report. By the time the cancer is caught, it’s too late to really make a difference. The study was published in the July 24, 2013 issue of the Journal of the American Medical Association.

The risk of being diagnosed also starts earlier for African-American women. We are more likely than women of other ethnicities to be diagnosed before age 44.

There is one particular type of breast cancer that is especially problematic for black women. It’s called triple negative, meaning the breast tumor is not being fueled by three receptors that typically drive the cancer to grow: estrogen, progesterone or another growth factor known as HER-2. Because most breast cancer treatments target these receptors, triple negative breast cancer is very difficult to treat, according to the National Breast Cancer Foundation. It’s also more likely to come back and spread, even after chemotherapy.

African-American women, young women and women with a particular genetic mutation are more likely to have this type of breast cancer.

Should you have a mammogram earlier?

This is why it’s so important for women—and not just baby boomers—to stay on top of any changes in breast tissue, paying particular attention to lumps. The CDC recommends that women start talking to their doctors about having a mammogram by age 40, and they advise having the screening every 2 years by age 50. I think black women need to be more proactive. African-American women in their 30s may want to talk to their doctors about having a mammogram if they have the following characteristics:

• Fibrous, dense breast tissue. This means the breasts have a less smooth texture that feels like smaller, softer lumps, which is common among African-American women with larger-sized breasts.

• A family history of breast cancer, particularly relatives who were diagnosed in their 40s or younger.

• A family history of women being diagnosed with benign—or not cancerous— lumps or tumors. Again, this is especially important if female relatives were found to have lumps in their 40s or younger.

• Any suspicious lumps, change in size or nipple discharge

Look for the best mammography services

If it’s time for your first or next mammogram, be selective about where you go. Convenience is always nice, and of course your insurance coverage gets a vote, but it’s equally as important to choose a healthcare facility that offers high quality digital mammogram services. Women with lower income or no insurance often go to facilities that may not offer the most advanced mammogram services.

The National Accreditation Program for Breast Centers outlines a list of standards women should look for when seeking services to screen or treat breast cancer, including:

• Genetic counseling and testing for women who have mothers, aunts or grandmothers who were diagnosed with breast cancer

• A multi-disciplinary medical team to discuss each patient. This means it’s not just one doctor, but a team with a surgeon, oncologist, radiologist, social workers and other clinical specialists

• Ongoing patient education about new clinical trials, advances in screening and how to navigate the process of getting screened and treated.

For the full list of standards, go to napbc-breast.org/standards/standards.html

Fortunately, University of Chicago is one of several hospitals on the South Side of Chicago that offers advanced services to screen and treat breast cancer. Roseland Community Hospital, located at 45 W. 111th Street, has also offers access to advanced digital mammograms that take less time and use less radiation.

We need to start thinking of mammograms just like we think of pap smears and vaccinations. It’s not an option. It’s a responsibility.

Dr. Doriane C. Miller is the Director of the Center for Community Health and Vitality, The Urban Health Initiative of the University of Chicago Medicine. For information on The Urban Health Initiative, visit uhi.uchospitals.edu.

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