Abstract P3-14-09: Breast cancer disparities through an imaging lens: Are black women more likely to have cancer detected on their first mammogram?
Authors: Wilkerson Avia , Obi Megan , Estrella Camila Ortega , Tu Chao , Pederson Holly , Al-Hilli Zahraa 
Published: March 2022

Abstract
Introduction Black women are more likely to be diagnosed with early-onset breast cancer, have triple negative disease, carry pathogenic variants in BRCA2, and are 41% more likely to die from the disease. The American College of Radiology recommends risk assessment for all Black women by age 30. Still, it remains unclear whether this population may benefit from earlier screening mammography. We evaluated women treated for breast cancer between ages 40 and 45 to determine the frequency of cancer detection on first mammogram for Black patients versus other racial/ethnic groups. We also analyzed risk factors associated with first mammogram-detected cancers. Methods Demographic, mammographic, and clinico-pathologic data were obtained from 724 women ages 40-45 who underwent oncologic surgery for breast cancer at our institution between 2010 and 2019. We defined first mammogram cancers as those with tissue diagnoses within three months of first mammogram. A logistic regression model was applied to assess the association of collected variables with cancer detection on baseline mammogram by racial/ethnic group. Results In the overall cohort of 724 patients, the mean age at breast cancer diagnosis was similar across ethnic groups (42.8 years, p=0.624). Black women were more likely to have a BMI greater than 30 (p=&lt;0.001), to be current smokers (p=0.033), to have a variant of unknown significance on germline genetic testing (p=0.049), and present with Stage 2 or Stage 3 disease. Black women were also significantly more likely to have breast cancer detected on their first mammogram (38/80, 47.5%) compared to White women (153/611, 25.0%) and Asian women (7/21, 33.0%) (p = &lt;0.001). One hundred ninety eight patients (27.3% of overall cohort) were diagnosed with breast cancer on their first mammogram. The mean age at diagnosis was similar across ethnicities within this subgroup (42.2 years, p=0.136). The only risk factor of statistical significance detected differentially in Black women among both the overall cohort and the subgroup of first mammogram cancer diagnoses was a BMI greater than 30. Black women with cancers detected on first mammogram presented more often with later stage disease, though this trend did not reach statistical significance (p=0.07). Conclusion Breast cancer screening guidelines for women age 40-45 vary. Unless a woman is evaluated based on family history and pedigree suggestive of hereditary cancer or familial clustering, there are no screening guidelines for women under age 40. Women identified with BRCA mutations, for example, would initiate high-risk screening at the age of 25, and even those with family history of early onset disease in the absence of a genetic mutation would initiate high risk screening to include contrast-enhanced MRI ten years earlier than the first affected relative. Our data suggests that Black women between age 40 and 45 are more likely to have cancer detected on their first mammogram. Early risk stratification and assessment, education and counseling on risk mitigation, and possibly initiation of earlier screening (even in the absence of family history) may be warranted in this group.
First Mammogram Cancers by RaceAllAsianBlackWhitep-valueN=712N=21N=80N=611Cancer on first mammogram, N (%):198 (27.8%) 7 (33.3%) 38 (47.5%) 153 (25.0%) &lt;0.001
Citation Format: Avia Wilkerson, Megan Obi, Camila Ortega Estrella, Chao Tu, Holly Pederson, Zahraa Al-Hilli. Breast cancer disparities through an imaging lens: Are black women more likely to have cancer detected on their first mammogram? [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P3-14-09.