International studies look to modify traditional breast cancer screening SAN ANTONIO-While the U.S. breast cancer community grapples with the nuts and bolts of mammography screening, Its international counterparts are working on enhancements and modifications to the screening process, which they presented at SABCS 2009.Researchers in Taiwan and China found that combining mammography and ultrasound led to a higher cancer detection rate in women aged 40-49. Meanwhile in the UK, the National Health Service will drop the age for baseline screening from 50 to 47 years by 2012, but a group from West Midlands Research Collaborative have made a case for starting screening at age 40 in certain ethnic groups.Earlier screening for minorities Previous reports have shown that ethnic minorities present with more advanced disease at a younger age, according to Soni Soumain, MD, and colleagues. “The West Midlands has a significant population of ethnic minorities who could potentially benefit from earlier screening,” they wrote in their poster. “We wanted to test this hypothesis by assessing the age and route of presentation of breast cancer across these ethnic groups.”The group collected data on patients treated for breast cancer from 2001 to 2007. They correlated patient age with mode of presentation (screening or symptoms) with ethnicity. Data were available for 528 women classified as Asian, 274 classified as African Caribbean, and 18,941 labeled as Caucasian (abstract 4008).Dr. Soni’s group found that the peak age of breast cancer incidence for Asian women and black women was 10-20 years younger than for white women. Among Asian women, 37% had their cancer found through screening, while 26% of African Caribbean women had disease presentation on screening. In the symptomatic group, 26.5% of Asian women and 35% of African Caribbean women were younger than 47 when they presented with disease vs 13% of the Caucasian population.The group stated that lowering the screening age from 50 to 47 should increase screen-detected cancers across the board, but they pointed out that based on their analysis, ethnic women present at a younger age. “We suggest the age of prevalent screening in these groups should be reduced further to 40 years,” they wrote. “This may increase detection of cancers at an earlier stage.”Dr. Soni acknowledged that this research had several limitations. First, there were no data indicating that starting screening at a younger age in minority women had an effect on mortality. Also, there is the issue of exposing younger women to more radiation over time. Finally, screening compliance has historically been low among ethnic minorities.However, Dr. Soni estimated that in his region, the compliance rate among ethnic women is already fairly high (between 70% and 75%).
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