Osei Beverley, Naganathan Gayathri, Daniel Juliet M, Kulkarni Supriya, Lofters Aisha, Oladele Yinka, Springer Leila, Omole Mojola
Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A1, Canada.
Department of Surgery, Michael Garron Hospital, Toronto, ON M4C 3E7 1A1, Canada.
Curr Oncol. 2025 Feb 22;32(3):123. doi: 10.3390/curroncol32030123.
Epidemiological data show racial and ethnic differences exist in breast cancer morbidity and mortality amongst Black, Indigenous, Asian, and Hispanic populations, with non-white females experiencing earlier age at diagnosis, more aggressive breast cancer subtypes and advanced cancer stages, and earlier mortality than white females. However, the current Canadian breast cancer screening guidelines recommend biannual screening for all females starting from age 50 to age 74 and suggest not to screen individuals aged 40-49. In May 2024, the Canadian Task Force for Preventative Health released updated draft breast cancer screening guidelines, maintaining such recommendations for screening. Both the existing and the proposed guidelines fail to account for the unique cancer burden amongst racialized populations in Canada and risk further perpetuation of existing racial and ethnic disparities by underscreening racialized females. This commentary will present data regarding racial disparities in cancer burden, highlighting the role social and biological factors play in impacting cancer risk and age of disease and presenting perspectives from stakeholder groups reflecting the impacts of current screening guidelines. Ultimately, we critique the current "one-size-fits-all" approach to breast cancer screening in Canada, emphasizing the need for adapted screening practices with the understanding that the current approaches overlook the needs of racialized Canadian populations.
流行病学数据显示，在黑人、原住民、亚洲人和西班牙裔人群中，乳腺癌的发病率和死亡率存在种族和族裔差异，非白人女性的诊断年龄更早，乳腺癌亚型更具侵袭性，癌症分期更晚，且死亡率比白人女性更高。然而，加拿大目前的乳腺癌筛查指南建议，所有50至74岁的女性每两年进行一次筛查，并建议不对40至49岁的人群进行筛查。2024年5月，加拿大预防健康特别工作组发布了更新后的乳腺癌筛查指南草案，维持了此类筛查建议。现有指南和拟议指南均未考虑加拿大种族化人群中独特的癌症负担，且可能因对种族化女性筛查不足而使现有的种族和族裔差异进一步长期存在。本评论将展示有关癌症负担种族差异的数据，强调社会和生物学因素在影响癌症风险和发病年龄方面所起的作用，并呈现利益相关者群体对当前筛查指南影响的看法。最终，我们批评加拿大目前“一刀切”的乳腺癌筛查方法，强调需要采取适应性筛查措施，因为我们认识到当前方法忽视了加拿大种族化人群的需求。
