WASHINGTON -- The formula doctors use to calculate a woman's risk of
breast cancer underestimates the danger for black women most of the time, and
especially for those 50 and older -- when they are most likely to benefit from
screening and protective drugs, according to the first major reassessment of the
widely used tool.
"We've been concerned about the assumptions we had to make for African American
women and other racial and ethnic groups for some time," said Mitchell H. Gail
of the National Cancer Institute, who led the re-evaluation of the formula he
developed. "It turns out that we have been underestimating the risk for African
American women."
The advance could have broad implications for many black women, prompting them
to reconsider the danger they face from a disease that is women's leading cause
of cancer and second-leading cancer killer.
That could translate into more women undergoing mammograms and other
examinations to detect the disease in its earliest, most treatable stages,
taking drugs such as tamoxifen to reduce their risk, and signing up for studies
evaluating better warning signs or risk-reducing medicines.
"This could very much change the way we counsel African American women," said
Nancy Davidson, a breast cancer expert who heads the American Society of
Clinical Oncology.
The new findings, published online Tuesday by the Journal of the National Cancer
Institute, are the latest revelations about how breast cancer and other diseases
can affect racial groups differently. A growing body of evidence suggests that
breast cancer tends to be much more aggressive and deadly among black women,
which could help explain why they are more likely to die from it even though
fewer of them get it.
"This is extremely significant," said Lovell A. Jones, director of the Center
for Research on Minority Health at the University of Texas M.D. Anderson Cancer
Center.
The new research examined the Breast Cancer Risk Assessment Tool, more commonly
known as the Gail model after the government biostatistician who developed it in
1989.
Because the model was based largely on data collected from about 240,000 white
women, Gail and his colleagues decided to try to develop a more accurate
alternative using data collected more recently on more than 3,200 black women.
