Identifying Equitable Screening Mammography Strategies for Black Women in the United States Using Simulation Modeling

Area of Science:

• Oncology
• Public Health
• Health Disparities

Background:

• Current mammography screening guidelines do not account for racial differences in breast cancer.
• Epidemiology, treatment, and survival rates vary significantly between racial groups.

Purpose of the Study:

• To compare the tradeoffs of different breast cancer screening strategies for Black women versus White women.
• To evaluate the efficiency and equity of various screening protocols.

Main Methods:

• An established simulation model from the Cancer Intervention and Surveillance Modeling Network was used.
• Race-specific inputs were utilized for breast cancer subtypes, density, mammography performance, treatment effects, and mortality.
• Screening strategies were simulated for a 1980 U.S. birth cohort of Black and White women until age 74.

Main Results:

• Biennial screening from ages 45-74 was most efficient for Black women; ages 40-74 was most equitable.
• Initiating screening 10 years earlier for Black women reduced mortality disparities by 57% with comparable life-years gained per mammogram.
• The choice of the most equitable strategy depended on assumptions about treatment effectiveness disparities.

Conclusions:

• Early initiation of biennial screening (age 40) for Black women is crucial for reducing breast cancer mortality disparities.
• This strategy provides benefit-harm ratios similar to those for White women screened biennially from ages 50-74.
• Tailoring screening guidelines to racial-specific epidemiology can improve health equity.