NEWPORT NEWS, Va. — Newport News radiologist Dr. Benjamin Pettus believes screening mammograms for Black women starting at age 35 — five years earlier than current recommendations for all average-risk women — could save lives.
“There are populations that I would definitely consider screening earlier so we can at least get an early baseline,” said Dr. Benjamin during our conversation about Riverside Health System’s use of artificial intelligence to help detect cancer. “If I had a platform, that would be something I would want done.”
I asked, “Do you think you’re going to have any success [changing the guidelines]?”
He answered frankly, “I don’t know.”
While five percent of breast cancer cases happen in women under 40 according to the Cleveland Clinic, the Centers for Disease Control report Black women under 35 are twice as likely to be diagnosed with breast cancer than white women. Additionally, data from the American Cancer Society reveals Black women are 40 percent more likely to die from breast cancer at any age compared to white women.
Breast cancer survivor Tawana Martin, who was diagnosed at 32 years old, supports earlier mammogram screening guidelines for Black women. She told me it took doctors months to take her concerns about five painful lumps seriously.
“It really saddens me, because it's too often young women don't make it because they're told they’re too young,” Martin shared with me during our conversation with tears falling from her eyes. She told me by the time doctors surgically tested the lumps for cancer, it was already at an advanced stage. She had to undergo a double mastectomy, chemotherapy, and radiation to save her life.
“I don’t want anyone to have to go through what I went through,” said Tasha Cade, another Black woman breast cancer survivor. As I’ve shared in previous reports, Cade was 41 years old and pregnant with her son when she was diagnosed with breast cancer. She said doctors didn’t fully investigate a painful lump in her breast for years. It wasn’t until her gynecologist demanded a surgeon perform a biopsy that the cancer was confirmed. Cade underwent a biopsy during her second trimester, and another after her son was born. She also told me she supports moving up guidelines for Black women.
“Just think of how many women's lives will get saved if we actually start a little bit earlier,” said Cade during our conversation.
I reached out to several other doctors to get their opinions on Dr. Pettus’ suggestion, including radiologist Dr. Stamatia Destounis. She helped form the American College of Radiology’s most updated guidance that urges all average-risk women to begin annual screening mammograms by age 40.
While she stopped short of agreeing with the idea of moving up the screening age guidelines for Black women in general, she does urge all women to do a risk assessment with their doctors beginning at age 25. She says the assessment, which would look at family history and genetic predisposition to cancer, could indicate initial breast cancer screenings at much earlier ages.
“I do think the risk assessment evaluation is very important,” she said during our conversation. “Maybe we'll be starting at 35 if we find you have risk factors, or 30 or 25.”
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She continued, “If you're identified as having a strong family history, at risk for having a genetic mutation, then we are […] starting screening [with mammograms, ultrasounds or MRIs] at an early age.”
I also spoke with Dr. Bruce Waldholtz, a gastroenterologist who volunteers with the American Cancer Society. He said more lives would be saved by putting a greater focus on improving lifestyle factors, like healthier weight and decreasing alcohol consumption, than moving up age guidelines. He also said increasing the number of women who start mammograms at 40 would be more beneficial, too.
The U.S. Preventive Services Task Force’s draft report this summer recommends average-risk women begin screening mammograms at age 40, and then every other year after that. Dr. Wanda Nicholson serves on the task force, and told me beginning screening mammograms earlier for average-risk women could create undo anxiety.
“The potential [for] false positive screening tests […]may cause women to undergo unnecessary biopsies, and perhaps unnecessary treatment,” said Dr. Nicholson during our conversation.
However, Cade and Martin said from their perspective, they believe the risk of false positives is worth the reward of finding cancer earlier for some women who might otherwise be dismissed like they were.
“Saving a life is always worth the risk,” said Martin. “There's no such thing as being too young. Cancer doesn't know an age.”
While Dr. Pettus’ idea hasn’t yet gained momentum in Virginia, the state of New York passed a law requiring insurance companies to cover annual mammograms for people as young as 35. Shannon’s Law is named for a Long Island teacher who died from breast cancer at 31 years old. The law went into effect in 2019.
The Hampton Roads-based organization Here for the Girls offers support and guidance for local breast cancer patients, especially those who’ve experienced early-age diagnosis or dismissals from doctors. You can connect to their community here.
Martin and Cade said their concerns about painful lumps were dismissed by their doctors, so I reached out to Cynthia Fisher with PatientRightsAdvocate.org to get advice for people whose concerns aren’t being addressed by their doctors.
- Seek a second opinion from another doctor or hospital if you believe your concerns about your condition are being dismissed or not being thoroughly investigated.
- Demand the doctor document your concerns and any refusal to perform advanced testing.
- Ask the doctor to explain the tests and tools available to rule out a disease, and why they are choosing not to explore those options.
- Make clear to doctors any family history of disease and demand they document it in their records.
- Seek assistance from a patient advocate to help communicate your concerns to your doctor.
