Controversial new breast cancer screening guidelines released by The American Cancer Society (ACS) on Oct. 20 may have particularly grave implications for African-American women.

Among the new recommendations, the ACS now suggests that women with an average risk of cancer begin having yearly mammograms at age 45—and not 40. After 10 years, those women could then begin having mammograms every other year. However, women at high risk—those with a family history of cancer, for example—should seek screening earlier and more often.

The new guidelines also discourages manual breast exams altogether, either from a medical provider or self-exams, since research shows no clear benefit, the ACS said.

ACS’ Chief Cancer Control Officer Dr. Richard C. Wender said while they understood some of the revisions would be divisive, they made them after much research and after balancing the benefits and the risks. One such risk is over-diagnosis. Sometimes a mammogram identifies something that seems suspicious but may actually be harmless. Verifying that, however, may include biopsies and other tests that carry risks of pain, anxiety and other side effects.

“We know that debates will continue about the age to start mammography,” said Dr. Wender. “This guideline makes it so clear that all women by age 45 should begin screening – that’s when the benefits substantially outweigh the harms.”

Still, the recommendation have raised concerns among some physicians, breast cancer survivors and others who believe earlier diagnosis can save people’s lives.

“This is a step in the wrong direction,” said Pennsylvania Breast Cancer Coalition (PBCC) President and Founder Pat Halpin-Murphy in a statement. “Most women we speak with would prefer to have a second mammogram or an ultrasound rather than to find cancer at a later, less treatable stage. The advent of 3D mammograms will alleviate much of the ACS’s concern over false positives since 3D mammograms reduce false alarms by 27 percent and increase early detection by 20 percent. The PBCC continues to recommend mammograms for women beginning at age 40 for the average woman until a more perfect test is developed.”

Breast screening is particularly important for African-American women, who are much likely to die of the disease. According to statistics, while White women have the highest incidence rates of cancer, Black women have the highest death rates from cancer. Among women aged 45–64 years, for example, the breast cancer death rate was 60 percent higher for Black women than White women, according to the CDC National Vital Statistics System.

In the past, the difference in survival rates were explained by lower screening rates among African-American women—which has since equalized; lower income-rates, lack of access to follow-up care after an abnormal mammogram and other factors.

But, “even after accounting for differences in income, past screening rates and access to care, African-American women are diagnosed with more advanced breast cancers and have worse survival than White women,” according to the Susan G. Komen website.

To find out more about the cancer screening recommendations, click here.