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Breast Cancer Screening (PDQ®): Screening - Health Professional Information [NCI] - Special Populations

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Young women

There is no evidence for performing screening mammography in average-risk women younger than 40 years.

Men

Approximately 1% of all breast cancers occur in men. Most cases are diagnosed during the evaluation of palpable lesions, which are generally easy to detect. Treatment consists of surgery, radiation, and systemic adjuvant hormone therapy or chemotherapy. Because of the rarity of the disease, it is extremely unlikely that any screening modality would be useful.

Individuals at Increased Risk of Breast Cancer and Thus Possibly With More to Gain From Screening

Women who have received thoracic radiation

Screening for breast cancer has been recommended for women exposed to therapeutic radiation to the chest, especially if they were exposed at an early age. One systematic review of observational studies of women exposed to large doses (≥20 Gy) of chest radiation before age 30 years found standardized incidence ratios of 13.3 to 55.5 for breast cancer, with no plateau with increasing age.[5] Screening mammography and magnetic resonance imaging can identify early-stage cancers in these women, but the benefits and risks have not been clearly defined.

Race

Although age-adjusted breast cancer incidence rates are higher in white women than in black women, mortality rates are higher in black women. Among breast cancer cases diagnosed from 2001 to 2007, 61% of white women and only 51% of black women had localized disease. The 5-year relative survival rate for localized disease was 99.3% for white women and 92.6% for black women; for regional disease, it was 85.2% for white women and 72% for black women; and for distant disease, it was 24.7% for white women and 14.8% for black women.[6] Both breast cancer incidence and mortality are lower among Hispanic and Asian/Pacific Islander women than among white and black women.[6] Survival in black women may be worse than in white women at least in part because of a higher frequency of adverse histologic features, such as a triple-negative phenotype.[7]

Several explanations for these findings have been proposed, including lower socioeconomic status, lower level of education, and less access to screening and treatment services. Population-based studies demonstrate that, compared with other groups, Medicaid recipients and uninsured patients of all races have later-stage breast cancer diagnosis, and survival from the time of diagnosis is shorter. These differences are associated with socioeconomic status and may reflect lack of participation in screening activities.[8,9] Black women older than 65 years are less likely to undergo mammogram screening. Among regular users of mammography, however, cancer was diagnosed in black and white women at similar stages.[10]

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