How Race and Ethnicity Can Affect Breast Cancer Risk and Screening Recommendations
Detecting breast cancer early can be life-saving. Breast cancer is the second most common cancer in U.S. women, according to the Centers for Disease Control and Prevention (CDC). And it’s the second leading cause of cancer deaths.
But did you know that your personal risk of getting breast cancer can depend on your race? Maybe you’ve heard in the news how some researchers think Black women should start getting breast cancer screenings earlier. We’re here to help you understand the breast cancer screening recommendations and whether your race and ethnicity matter, so that you can be proactive and protect yourself.
How common is breast cancer among different racial groups?
About 1 in every 8 women in the U.S. will be diagnosed with breast cancer in their lifetime. But when we look at breast cancer stats by race, we start to see different patterns.
For example, Black, Hispanic/Latino, and Asian women have a slightly lower risk of breast cancer compared to white women. And of all major ethnic backgrounds, Native American women have the lowest risk of getting breast cancer.
But if we look only at women younger than 45 years old, Black women are most likely to be diagnosed with breast cancer. That’s largely because Black women have a higher risk of getting an aggressive, hard-to-treat form of breast cancer called triple-negative breast cancer (TNBC) that mostly affects younger women.
Here’s what breast cancer rates look like in various racial groups in the U.S.
| Race/Ethnicity | Risk of getting breast cancer in their lifetime |
|---|---|
| White | 13% |
| Black | 12% |
| Hispanic/Latino | 11% |
| Asian/Pacific Islander | 11% |
| American Indian/Alaskan Native | 8% |
What are the major risk factors for breast cancer?
Some risk factors for getting breast cancer are unavoidable since they’re linked to our genes. For example, a woman who has a parent or siblings with breast cancer has a higher risk of developing breast cancer herself than if she had no family history.
Another genetic factor that increases the risk of breast cancer, ovarian cancer, and other cancers is a mutation, or change, in two breast cancer genes: BRCA1 and BRCA2. Everyone has BRCA1 and BRCA2 genes. They help prevent cancer from forming in the body.
When these genes become mutated, your risk of developing breast cancer or ovarian cancer is higher. And you’re also more at risk for developing breast cancer before age 45.
Overall BRCA mutations are rare, but Ashkenazi Jewish women are more likely to have them compared to the general population. BRCA1 or BRCA2 mutations are present in:
About 1 of every 400 women in the general population
About 1 of every 40 Ashkenazi Jewish women
Other risk factors that can increase the risk of getting breast cancer are:
Obesity and weight gain
Lack of exercise
Poor eating habits
Alcohol use
Smoking
We know that people in minority groups disproportionately live in environments that tend to promote these risk factors. For example, they may live in areas where it’s harder to access quality healthcare, green spaces for exercise, or grocery stores with fresh produce.
What are options for breast cancer screenings?
Breast cancer screenings look for signs or symptoms of cancer in a woman’s breasts. They don’t prevent cancer, but they can help find cancer earlier.
You may have heard statements like “early screenings save lives.” That’s because regular screenings can help identify breast cancer earlier and lower the chances that a woman dies from it.
You have several options for breast cancer screening. Here’s an overview of some of the most common options.
1) Breast self-exam (BSE)
A breast self-exam is a way to check your own breasts for any changes. Ideally, you should do a breast self-exam monthly. A common recommendation, at least for women who have monthly periods, is to do the self-exam 7 to 10 days after your period starts. Scheduling it around your period helps you remember to do it. At that point in your cycle, your breasts shouldn’t be as tender as they may be at other times.
During a breast self-exam, you’re looking out for changes from month-to-month. Some women’s breasts feel different than others. Yours may naturally feel more bumpy. Let your healthcare provider know if you notice changes in the way they feel.
2) Clinical breast exams
A clinical breast exam is one that a trained healthcare provider will do during a medical checkup. In many cases, you’ll get a clinical breast exam during your yearly well-woman visit. You might be sitting up and lying down at different times during the exam. The healthcare provider will look at your breasts to take note of any changes and will also use their hands to feel the tissue around your breasts and underarms for any changes.
3) Mammograms
Mammograms may be the most talked-about breast cancer screening method. Using low-dose X-rays, a screening mammogram shows abnormal tissue in the breast. If abnormal tissue is found, it doesn’t necessarily mean cancer, but you’ll likely need to have more tests — like a diagnostic mammogram — to find out what’s going on. Different from a screening mammogram, a diagnostic mammogram can tell a healthcare provider whether that tissue is cancerous.
4) Breast MRI
A breast magnetic resonance imaging (MRI) uses radio waves and strong magnets to make detailed pictures of the breast. It’s recommended for certain women with a high risk for breast cancer, but isn’t a substitute for a mammogram.
Do breast cancer screening recommendations differ by race?
Now that we’ve discussed who breast cancer affects and what screening methods are available, you may be wondering if women of different races should be screened for cancer differently.
Providers often use two breast cancer screening guidelines to help inform their care. These are published by:
Neither specifically calls out women of different races to be screened differently than women of other races. But screening recommendations for high-risk women can differ from those of average-risk women, and it’s worth noting that women of certain races are more likely to be considered high-risk than others.
So your first step is to figure out your personal breast cancer risk with the guidance of your healthcare provider. Then, your provider will work with you to follow the breast cancer screening recommendations for your risk level.
Evaluating your personal breast cancer risk
Evaluating your breast cancer risk doesn’t necessarily mean getting a mammogram or other screening test done immediately. It means having a discussion with your healthcare provider about your risk factors, so that you can both determine whether you may need to have screening done earlier than age 40.
Having that conversation is the best way to know for sure what your risk level is, but here’s an idea of what risk factors your provider will consider. The more of the following risk factors you have, the higher your risk for breast cancer:
BRCA1 or BRCA2 mutation, based on genetic testing
Strong family history of breast cancer or BRCA1 or BRCA2 mutation, especially in a parent, child, or siblings
Past history of breast cancer
History of chest radiation between age 10 and age 30
Other factors that go into evaluating your personal breast cancer risk include:
Your age
Your race or ethnicity
How old you were when you got your first period
Whether or not you’ve given birth, and if you have, how old you were at the time of giving birth to your first child
If you don’t have any or many of these risk factors, you may be at average risk.
Here’s a summary of what the breast cancer screening guidelines recommend for women with average and high risk levels.
Guidelines from the American College of Radiology and the Society of Breast Imaging
Women with an average risk of breast cancer should begin getting annual mammograms at age 40.
Women with a high risk of breast cancer should start getting regular mammograms before age 40.
In a 2018 update, the ACR added that all women, especially Black women and those of Ashkenazi Jewish descent, should have their breast cancer risk evaluated by age 30. That’s because, as we mentioned above, women in these two ethnic groups have a higher risk of getting breast cancer when they’re younger.
Guidelines from the American Cancer Society
Women with a high risk of breast cancer should begin getting yearly mammograms and breast MRIs at age 30.
Women with an average risk of breast cancer should begin getting regular mammograms at age 45, but should have the option to start at age 40 if they’d prefer.
Women ages 45 to 54 should get a mammogram every year.
After age 54, women should get mammograms every other year, unless they’d like to continue them every year.
The ACS actually doesn’t recommend breast self-exams or clinical breast exams for women with an average risk of breast cancer due to a lack of evidence that they work, along with the rate of false positives.
The bottom line
Breast cancer can often be cured if you catch it early. This is why screenings are so important. Be proactive about talking to your provider about when you should get screened because recommendations for individual women can vary.
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