“BLACK WOMEN are more likely to develop breast cancer at a younger age, compared with white American women, and at all ages, younger and older individuals are more likely to develop triple-negative breast cancers,” Lisa A. Newman, MD, MPH, told The ASCO Post. “So, I think it is very clear that if all women wait until they reach age 50,” the age listed in the U.S. Preventive Services Task Force screening mammography recommendation, “we are going to see a widening of the mortality gap related to delayed diagnoses of triple-negative breast cancers in young women,” Dr. Newman added. Dr. Newman is Chief of the Section of Breast Surgery, Weill Cornell Medicine Cancer Center, and of the Breast Surgical Oncology Program, NewYork-Presbyterian, Weill Cornell Medicine Cancer Network, New York.
To ascertain the implications for breast cancer screening recommendations of higher burden of triple-negative disease among black women, Dr. Newman and colleagues reviewed data from the California Cancer Registry for more than 375,000 invasive breast cancers diagnosed between 1988 and 2006.1 “The population-based rates of triple-negative tumors are higher for black women in their 40s, compared with those rates for white women in their 50s,” Dr. Newman noted in her presentation at the 2018 Lynn Sage Breast Cancer Symposium, hosted by the Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago.2
Early Detection Equals Better Outcomes
“THE CRITICS of screening mammography are quick to point out that triple-negative breast cancers are more likely to present as interval breast cancers, and so screening may not necessarily have an impact on outcome from this disease. But this argument is refuted by data from the Memorial Sloan Kettering Cancer Center, where the investigators looked at nearly 200 women diagnosed with T1b node-negative breast cancers that were all triple-negative, more than two-thirds of which were diagnosed by screening imaging. They found that outcome from these early detected triple-negative breast cancers was excellent, at over 90%, regardless of whether the women received adjuvant chemotherapy or not,” Dr. Newman reported.
At the Henry Ford Health System in Detroit, Dr. Newman’s previous affiliation, “we looked at the impact of mammography screening and a host of other features in terms of predicted survival for triple-negative breast cancer in our black patients compared with our white patients,” she reported. Even after adjusting for those different features, “we indeed found that mammography screen-detected disease was the most important predictor of better outcomes for both our black and white patients with triple-negative breast cancer,” Dr. Newman stated.
“I would argue that mammographic screening is one of our most powerful protections at this point in time against breast cancer mortality disparities,” she concluded. ■
DISCLOSURE: Dr. Newman reported no conflicts of interest.
1. Amirikia KC, Mills P, Bush J, et al: Higher population-based incidence rates of triple-negative breast cancer among young African-American women: Implications for breast cancer screening recommendations. Cancer 117:2747- 2753, 2011.
2. Newman LA: African ancestry and high-risk/triple-negative breast cancer. 2018 Lynn Sage Breast Cancer Symposium. Presented October 11, 2018.