Posted September 21, 2010
Mexican-American women are diagnosed with breast cancer at a significantly younger age than Caucasian women, a surprising finding from a new study that raises more questions about the recent push to delay routine screening.
University of Texas M.D. Anderson Cancer Center researchers surveyed women in Hispanic neighborhoods in Harris County and found nearly half of those with the potentially deadly disease were diagnosed before they turned 50, about 10 years earlier than the national average for all women.
“This study shows the need to consider all populations when developing prevention and screening strategies,” said Melissa Bondy, an M.D. Anderson epidemiologist and the study’s senior corresponding author. “The problem is there simply haven’t been enough studies of minority populations to develop strong risk assessment models necessary for optimal screening strategies.”
The study suggests a huge number of breast cancer cases wouldn’t be caught at early stages under new screening guidelines issued last year by the U.S. Preventive Services Task Force. Those guidelines now call for women without known breast cancer risk factors to start getting mammograms at 50 instead of 40.
Larger study needed
Bondy acknowledged that the findings need to be verified in a larger study, but added that M.D. Anderson researchers are finding similar results in a larger study now under way. The team interviewed 122 Mexican-American women with breast cancer for the study, which was authored by Patricia Miranda, an M.D. Anderson post-doctoral fellow, and published online at Cancer, the journal of the American Cancer Society.
Dr. Ned Calonge, chairman of the U.S. Preventive Services Task Force, stood by the panel’s new guidelines, emphasizing they call for women to make screening decisions based on discussions with their doctor rather than routinely begin at 40. He said the new data should help inform those discussions.
But 37-year-old Elvira Bautista, an M.D. Anderson patient who was diagnosed last year, said because she’s so young and has no family history of cancer, neither she nor her doctors suspected cancer when “something” she felt in her breast two years ago seemed like it was related to a car accident she’d been in recently.
“It turned out to be aggressive Stage 2 cancer,” said Bautista, a Brownsville area woman participating in the larger, ongoing study. “Imagine if I thought I didn’t need to get a mammogram until I was 50. I wouldn’t have lasted for long.”
Louise Villejo, president of the board of directors of Houston’s Hispanic Health Council, said this is the first she’s heard Mexican-American women diagnosed breast cancer at such an early age. She said she was surprised because U.S. Hispanics have a lower breast cancer incident rate than Asians, blacks and non-Hispanic whites.
Despite that lower incident rate, an American Cancer Society report last year found U.S. Hispanics are more likely to be diagnosed with the disease at a later stage and die of it. Bondy said the new M.D. Anderson study likely explains why.
Researchers have increasingly looked at racial disparities in health care in recent years, but most of the breast cancer attention has focused on blacks, who aren’t faring any better now than two decades ago, despite treatment advances that have benefited whites during that time. Relatively little attention has been paid to Hispanics.
22,000 interviews
Attempting to remedy that, M.D. Anderson researchers have conducted face-to-face interviews with about 22,000 Mexican-American Harris County residents since 2001. For the Cancer study, they categorized each one diagnosed with breast cancer.
The average age of diagnosis was 50.5, researchers found. They also found 48.7 percent were diagnosed before 50; 34.8 percent at 45 or younger; and 21.7 percent at 40 or younger.
By contrast, 61 is the average age of diagnosis for all U.S. women, according to the National Cancer Institute. Only 35 percent are diagnosed before 55.
Fifteen percent of the Mexican-American women with breast cancer in the M.D. Anderson study had a family history of the disease.
The U.S. Preventive Services Task Force guidelines caused a firestorm when announced in November 2009. They represent an attempt to reduce overscreening’s potential harm — mammograms produce false-positive results in about 10 percent of cases, causing not just anxiety but sometimes unnecessary follow-up tests and treatment. But others argue that they’ve played a key role in reducing the disease’s death toll and argue that less screening would undo the progress.
M.D. Anderson’s larger study is looking to enroll as many as 3,000 breast cancer patients and survivors of Mexican descent in Texas, Arizona and Mexico.
todd.ackerman@chron.com
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