Breast Cancer Screening in Black Patients

In the United States, breast cancer is the second leading cause of death in women assigned female at birth. Although mortality rates from breast cancer have declined over time, Black women are 40% more likely to die from the disease than White women. While instances are rare, transgender women can develop breast cancer as well.

Breast cancer is curable if found in the early stages. Studies show outside of biologic and genetic differences, this racial disparity is due to decreased access to screening exams such as mammograms.

This article discusses early breast cancer detection through proper screening to reduce breast cancer mortality rates in Black patients, particularly Black women.

Breast Cancer Screening Guidelines

Breast cancer screening is the same for Black and White women. The guidelines below are recommended for women at average risk of breast cancer.

• Women 40–44: The option to begin yearly breast cancer screening with mammograms
• Women 45–54: Recommended to get a yearly mammogram
• Women 55 and older: A mammogram every two years (yearly if at high risk for developing the disease)

Women at increased risk of developing breast cancer should be screened with a mammogram and a breast MRI annually, starting at 30. High-risk women are those with a 20%-25% lifetime risk of developing breast cancer, based on family history and the factors below:

• People who have a known BRCA1 or BRCA2 gene mutation
• Have a close relative (parent, brother, sister, or child ) with the BRCA 1 and 2 mutations
• Have had radiation therapy to the chest between the ages of 10–30 years
• People with (or close relatives with) syndromes such as Li-Fraumeni syndrome, Cowden syndrome, or Bannayan-Rile-Ruvalcaba syndrome

Breast Cancer Screening in Black Patients

Black patients, particularly Black women, are screened for breast cancer less often and experience longer times between screenings. Additionally, follow-up after an abnormal breast cancer screening test is prolonged in Black women compared to White women. These inequities lead to the development of advanced-stage breast cancer, which is incurable.

Access to Screening

Although White women are developing breast cancer at a higher rate than Black women, the healthcare community must continue to investigate and resolve why Black patients are more likely to die from the disease.

Studies show that poor access to breast cancer screening is the leading cause of this inequity. Lack of insurance, childcare, transportation, and employment constraints affect the ability of Black women to access screening exams. Other factors that decrease breast cancer screening in Black patients include:

• Fear/anxiety
• Mistrust of the healthcare system
• Knowledge deficits
• Comorbidities
• Sociocultural beliefs
• Poor patient-provider interaction and information sharing
  

Types of Breast Cancer Screening

Breast cancer screening tests can help identify the disease while it's smaller and hasn't spread to other organs. Early detection improves prognosis and survival rates.

Mammogram

A mammogram is an X-ray of the breast. It can be used to screen for breast cancer, or it can help rule out the disease in people with suspicious breast findings, such as:

• A new lump
• Nipple discharge
• Skin changes
• Change in size

During a mammogram, a technician places a breast (one breast at a time) between two plastic plates, which help press the breast flat. Patients with all sizes of breasts and breast implants can get a mammogram. Although the procedure may be uncomfortable, it lasts only a few minutes.

Mobile mammogram buses are available in some areas, which help reduce the difficulty of patient travel. Search "mobile mammography near me" to find this resource in your region.

Breast Ultrasound

A healthcare provider may order a breast ultrasound to get more information if a mass is discovered on a mammogram. An ultrasound uses sound waves to determine if a mass is solid or fluid-filled (cyst). A breast ultrasound is also used to help guide a needle during a breast biopsy.

MRI

Magnetic resonance imaging (MRI) of the breast helps identify breast cancer in patients with a high risk for breast cancer or those with dense breast tissue. An MRI uses a powerful magnetic field and radiofrequency pulses to obtain pictures of internal structures that cannot be found with mammography or breast ultrasound.

Other

Breast-self exams (BSE) enable people to become familiar with their breasts. BSEs provide valuable information about the breasts' texture, color, size, and shape, allowing people to identify new changes. The most accurate time to perform a BSE is a few days after a menstrual cycle each month. It's important to remember that a BSE is not a replacement for breast cancer screening.

How to Get Screened

Black women have reported a lack of trust in the healthcare system; therefore, finding a dependable healthcare provider is essential to developing a trustworthy relationship. Health in Her Hue is a digital platform that helps connect Black women to culturally competent healthcare providers.

Once established with a healthcare provider, they will perform a health assessment, which includes reviewing your family's medical history. Based on this information, they will recommend the type of breast cancer screening exam best for you. Your healthcare team will help arrange your screening test and provide an order for the exam.

Cost of Screening

Depending on where you live, the average cost of a mammogram in the United States is between $100–$250. In 2010, the Affordable Care Act (ACA) began requiring health plans to cover the total cost of mammograms without a copay starting at age 40. Medicare and Medicaid also cover the entire cost of a mammogram.

Be sure to let a healthcare provider know if financial concerns are preventing you from getting breast cancer screening. They may be able to provide a list of local organizations that can help.

If uninsured or underinsured, resources such as the National Breast and Cervical Cancer Early Detection Program, Susan G. Koman Foundation, and the American Cancer Society can help you find a free or low-cost mammogram.

Summary

Despite declining breast cancer mortality rates in the United States, Black women are still 40% more likely to die from the disease than White women. This racial disparity is caused by the lack of early breast cancer detection in Black women. When breast cancer is caught early, treatment can be started sooner, improving survival rates. Understanding and resolving the barriers to breast cancer screening faced by Black women is key to improving their survival.

A Word From Verywell

If you are a Black woman, you must know that you can significantly decrease your risk of dying from breast cancer with early detection. Breast cancer is curable if caught in the early stages. Connect with a healthcare provider you feel comfortable with who understands your unique barriers to screening so a breast cancer screening plan can be designed to fit your needs.