By Diane Loupe
Tuesday, June 22, 2010
Doctors debate the screening implications of triple-negative breast cancer, a particularly deadly form of breast cancer that strikes earlier, produces larger tumors, resists common treatment and is prevalent among women of West African descent.
"Triple-negative breast cancers are, on average, occurring in younger women, with bigger tumors and the cells are dividing more quickly," said Dr. Rebecca Dent, an assistant professor at the University of Toronto, who also works at Sunnybrook Odette Cancer Center in Toronto. These cancers tend to spread into the lung, brain and liver, and are less likely to go to bone, Dent says.
Since the incidence of this type of cancer is higher among black women, particularly those of West African descent, they should be getting earlier screening for breast cancer, says Dr. Bert M. Petersen, Jr., a leading researcher of triple-negative breast cancer and managing partner of Global Cancer Control in New York City.
Petersen says he finds any way he can to screen African American women for breast cancer starting at the age of 35.
"While white women have the highest rate of breast cancer in this country, African American women have the highest rate of breast cancer under the age of 50," said Petersen. Black women are the least likely to be screened for breast cancer, he adds.
Newman recommends that African American women get mammograms starting at age 40. Among women with a strong family history of early onset breast cancer, Newman recommends starting mammograms when a woman is five to 10 years younger than the youngest age of a breast cancer diagnosis in her family.
But the push for earlier screening is controversial.
Dr. Ned Calonge, chairman of the U.S. Preventive Services Task Force and chief medical officer of the Colorado Department of Public Health and Environment, says early detection does not necessarily extend lives.
Calonge's group, which provides recommendations on a wide range of preventive services, ignited a firestorm of criticism last year when it recommended against routine screening mammography for women under the age of 40. The group argued that these screenings are more likely to result in false-positive test results, over diagnosis and unnecessary earlier treatment.
Routine mammograms for women between the ages of 40 and 50 are associated with a 15 percent reduction in mortality, according to a study looking at eight years of data that was published in November in the Annals of Internal Medicine.
"This means that of seven women who participate in mammographic screening and have breast cancer, six will die of their breast cancer, in spite of mammography," Calonge said.
Despite the tentative status of the research into triple-negative breast cancer, University of Michigan's Newman argues in favor of more, earlier screening. For one thing, mammography technology was not as sophisticated in previous trials, Newman says.
"There are many reasons to suspect that the benefits of mammography may actually be substantially greater for younger age women as well as for older age women compared to what was documented in those older studies," she said.
Unless women have a significant family history, it may be difficult for African American women under the age of 40 to get screened, says Global Cancer Control's Petersen. Some insurance plans won't cover diagnostic mammograms at this age, unless accompanied by some other symptom, such as breast pain.
To learn more about the disease, Petersen plans to start collecting tissue of women in West Africa who have been diagnosed with breast cancer. He is talking with Ghanaian officials to create a tissue bank of normal tissue, not just to study breast cancer, but other diseases prevalent among those of African ancestry, such as hypertension, diabetes and tuberculosis. Such data could lead to more effective ways to treat these diseases.
Diane Loupe is a freelance writer and editor in Decatur, Ga.
Triple Negative Breast Cancer Foundation
Living Beyond Breast Cancer's Guide to Understanding Triple-Negative Breast Cancer, a patient-friendly guide to current research and treatment options.
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