HJAR Sep/Oct 2023

56 SEP / OCT 2023 I  HEALTHCARE JOURNAL OF ARKANSAS DIALOGUE COLUMN ONCOLOGY IN MAY OF THIS YEAR, the American Col- lege of Radiology (ACR) published new breast screening guidelines that call for all women, particularly Black women as well as Ashkenazi Jewish women, to have a risk assessment by age 25 to determine if screen- ing prior to age 40 is needed. These changes are designed to promote earlier and more intensive screening for high-risk patients — “high-risk” meaning those with a 20% or greater lifetime chance of developing breast cancer compared to the average risk of 10- 12%. Annual screening starting at age 40 is still recommended for women of average risk. With these new guidelines, theACR reclas- sified Black women and other minorities as high risk compared to non-Hispanic white women, and for good reason: • Prior to age 50, minority women are 72% more likely to be diagnosed with breast cancer, 58%more likely to be diagnosed with advanced-stage breast cancer, and 127%more likely to die of breast cancer. • Black women are 42% more likely to die from breast cancer, despite roughly equal incidence rates. • Black women are less likely to be di- agnosed with stage I breast cancer, but twice as likely to die of early breast cancers. • Black women have a two-fold higher risk of aggressive, “triple-negative” breast tumors and a higher risk of BRCA1 and BRCA2 genetic mutations (placing them at higher risk). Clearly, widespread use of risk assessment tools at an earlier age — leading to more in- formed, intentional screening — could im- prove breast cancer detection, treatment and outcomes for Black and other minority pa- tients. The newACR guidelines also include the following recommendations for these high-risk patient groups: • Women with genetics-based increased risk — including BRCA1 carriers, those with a calculated lifetime risk of 20% or more, and those exposed to chest radia- tion at a young age — are recommended New Guidelines Recommend Earlier and More Intensive Breast Screening for Black Women, Other High-Risk Patients