The Health Divide: New breast cancer screening guidelines aim to help Black women

A national task force recommended last week that women begin regular mammograms at age 40 and every two years thereafter, an update meant to “counteract growing rates of breast cancer in younger women and reduce racial disparities in deaths,” reports Karen Kaplan at the Los Angeles Times.

That’s a change from earlier recommendations, from the same U.S. Preventive Services Task Force, that advised women to start mammograms at age 50. Rates of invasive breast cancer in young women have been accelerating since about 2015. 

Black women are particularly at risk of breast cancer, with a greater likelihood of being diagnosed with cancer at stage 2 or higher, when the tumor is larger than two centimeters across or has spread from breast tissue to lymph nodes. 

And Black women have the highest rates of death from breast cancer, too — about 40% higher than white women — in part due to their likelihood of being diagnosed at later stages. 

The disparity in breast cancer deaths has been attributed to higher rates of breast cancer-promoting genes in Black women Scientists have also found biological differences in how breast cells deal with DNA repair, an important factor in preventing cancer, between Black and white women. There are also social and economic inequities, including unequal rates of health coverage, resulting from structural racism. 

The additional screening is poised to provide “even more benefit for women who are Black,” task force vice chair Dr. John Wong told Carla K. Johnson at AP News. 

The panel calculated that moving the screening age a decade earlier would save 1.3 lives per 1,000 women overall, and 1.8 deaths per 1,000 Black women. 

“I think we do need additional studies to look at whether there are different screening strategies that would be more helpful to Black women,” the panel’s chair, Dr. Wanda Nicholson, told CNN’s Jacqueline Howard. 

A rural address raises death risk, according to CDC  

Living in a rural area increases one’s risk of all five top causes of death in the U.S., reports Mary Kekatos at ABC News. 

A new CDC report specifically focused on preventable deaths, excluding COVID-19, in people younger than 80, from 2010 through 2022. 

Researchers found that Americans living in rural areas were more likely to die from heart disease, cancer, injury, stroke or chronic lower respiratory disease than urban dwellers.  

Demographics also contributed to death rates: “The highest rates of premature deaths were observed in rural counties where a majority of the population was Black, African American, American Indian, or Alaska Native,” the report said. 

Causes may include lack of health insurance, distance from clinics, and high blood pressure and obesity among rural populations, Kekatos writes. 

The CDC is trying to bolster rural health by funding programs such as cancer screening for women and physical education in schools, she reports. 

New rule bars discrimination against people with disabilities in health care 

The U.S. Department of Health and Human Services is finalizing a rule that will reduce discrimination against people with disabilities in health care settings, reports Michelle Diament at Disability Scoop.   

The new regulations will prohibit providers from denying people treatment, such as organ transplants, based on stereotypes or biases about the value of a patient’s life or their potential burden to others. 

The rule will also require many providers to update their equipment to include accessible exam tables and scales within two years. 

Discrimination against people with disabilities remains a persistent problem in health care, reports Michael Roppolo at CBS News, resulting in many people with disabilities delaying or avoiding treatment. 

And more than 16,000 people with developmental and intellectual disabilities are housed in institutions, even though studies show many people with intellectual disabilities are better off living in community settings. Roppolo’s sources view institutional living as a separate but unequal system, rooted in discrimination. 

A 2020 study found that most health care providers have a moderate bias against disabled people. In another study, only 41% of doctors said they were “very confident” they could fully care for disabled patients. 

The result, Roppolo reports, is a system in which in which people in wheelchairs are sometimes sent to supermarkets or beef plants for weigh-ins because the doctor’s office scale can’t accommodate them. He cites cases of doctors suggesting disabled patients undergo sterilization and physicians assuming patients with Down syndrome or other developmental disabilities will be institutionalized. 

“I don’t know anybody that would choose to live in an institutional setting,” Rebecca Cokley, a disability rights program officer at the Ford Foundation, a private entity that promotes equal rights, told CBS. “The system continues to perpetuate the idea that institutions are an actual choice.” 

The new HHS rule is “long overdue,” Melanie Fontes Rainer, director of the HHS Office for Civil Rights, said in a press release. “No diagnosis should be missed because of an inaccessible mammogram, no patient should be left with questions about test results due to inaccessible websites and no life should be valued less due to disability.” 

The rule specifically applies to any programs that receive HHS funding, including both health care and child welfare settings. 

HHS’ next steps include educating people about their rights and helping providers understand the rules, reports Noah Tong at Fierce Healthcare. 

Darcy Millburn of The Arc of the United States, a rights organization for people with intellectual and developmental disabilities, told Disability Scoop the rule is “a big step forward in removing barriers in our health care system.” 

What else could a make difference? Broad education about disabilities and accommodations in health care practices would help, Dr. Mai Pham told CBS. She is founder of the Institute for Exceptional Care, and has a son with autism. 

Pham’s group includes people with disabilities in all its discussions. That inclusion, and better data collection, can help their voices be heard, writes Roppolo. 

“Person-centered” health care will “ensure that people don’t fall through the cracks,” said Cokley, who was born with a form of dwarfism and has children with disabilities. 

Courts, Biden admin take action to support LGBTQ+ health care 

A federal appeals court ruled last week that government-sponsored insurance cannot refuse gender-affirming health care for transgender people. 

The 4th U.S. Circuit Court of Appeals issued the ruling, stating the cost of treatment is not grounds for denial, in cases involving North Carolina state employee health insurance and West Virginia Medicaid. It’s the first Court of Appeals decision in a series of similar cases across the country, reports Leah Willingham at AP News. 

West Virginia Attorney General and gubernatorial candidate Patrick Morrisey vowed to appeal the ruling to the Supreme Court. 

In related news, the Biden administration announced a rule that prohibits discrimination against LGBTQ+ individuals in health care, report Dan Diamond and Fenit Nirappil at The Washington Post.  

The rules set forth by U.S. Department of Health and Human Services apply to health insurers managing government plans and organizations that receive federal funds. 

These protections were issued during the Obama administration, but eliminated during the Trump years. Conservative lawmakers still aim to block the protections, reports the Post. 

It will be possible for religious organizations to get exemptions, reports Orion Rummler at The 19th. 

From the Center for Health Journalism 

• Virtual Domestic Violence Symposium May 9, 8:30 am – 2:30 pm PDT: The free online event will discuss the state of domestic violence today, the intersection between domestic violence and homelessness, the challenges of reporting on this topic, and new approaches and developments in the field. Attendees are eligible to apply for reporting grants (see below). Open to journalists nationwide. Sign-up here! 
• Apply for the Domestic Violence Impact Reporting Fund by May 23: Grantees receive reporting grants of $2,000–$10,000 and five months of professional mentorship from a veteran journalist. Find out more here.
• Webinar May 21, 11 a.m.–12 p.m. PT: How Can Health Care Do Better for LGBTQ+ Patients?: Featuring Carey Candrian of the University of Colorado School of Medicine; Jen Christensen of CNN’s Health, Medical and Wellness Unit; and Lindsey Dawson of KFF. Sign-up here!

What we’re reading 

• Anti-LGBTQ+ policies have an alarming effect on youth mental health, survey finds,” by Solcyré Burga, Time 
• “More than a third of all Americans live in communities with ‘hazardous’ air, Lung Association finds,” by Victoria St. Martin, Inside Climate News 
• “Black families left at risk as U.S. delays menthol cigarette ban,” by Margo Snipe, Capital B News 
• “FDA misses own deadline to propose ban on cancer-linked formaldehyde from hair relaxers,” by Michelle Garcia, Berkeley Lovelace Jr. and Janelle Griffith, NBC News 
• “State legislators are taking the maternal mortality crisis into their own hands,” by Darreonna Davis, The 19th 
• “Myth of ‘superhuman strength’ in Black people persists in deadly encounters with police,” by Shahid Meighan, Nathan Collins and Elena Santa Cruz, AP News 
• “Genetics studies have a diversity problem that researchers struggle to fix,” by Lauren Sausser, KFF Health News