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It's MORNING EDITION from NPR News. Renee Montagne is away today, back tomorrow. I am Steve Inskeep. Good morning. New recommendations on breast cancer screening have generated both confusion and anger about when women should start getting mammograms. And that is especially true for African-American women.

The recommendations shifted the average age a woman should start to be screened from 40 years old to 50. But African-American women die of the disease far more often than others at an earlier age. NPR News's Brenda Wilson reports.

BRENDA WILSON: When you look at the death statistics for breast cancer in African-American women and compare them to white women, it's stunning. Beginning in their 20s, black women are twice as likely to die of breast cancer as white women who have breast cancer. In older black women, there are fewer cases of breast cancer, but the high death rates persist.

Vanessa Sheppard is a behavioral scientist at Georgetown University. She's conducting a study to understand the response of African-American women to treatment for breast cancer, so she's seen this up close.

Dr. VANESSA SHEPPARD (Behavior science, Georgetown University): In my study, we've lost - and this has been a relatively small study - but we've lost about eight African-American women. And that's a pretty high mortality rate in about 200 women. So that's pretty high so far. And personally, I've lost friends that were 32, 36 and 40 from breast cancer.

WILSON: Studies estimate that 20 to 30 percent of breast cancers in African-American women are triple-negative breast cancers. They don't respond to any of the treatments known to block the cancer's growth.

Dr. SHEPPARD: The breast cancer is more aggressive, meaning that the tumors are harder to treat. They're larger.

WILSON: Similar types of aggressive breast cancers have been found in other ethnic groups, including Africans, suggesting, perhaps, a genetic link. But no one knows exactly why. There are known risk factors for breast cancer and combinations of risk factors - a family history of the disease, age at which menstruation and menopause start. But no one has come up with a satisfactory model to predict breast cancer in black women.

Lovell Jones is the head of the minority research center at the M.D. Anderson Cancer Center in Houston. He says what's happening with breast cancer death rates is similar to what's happening with the higher infant mortality rate in the African-American community.

Dr. LOVELL JONES (Director, M.D. Anderson Cancer Center): What it gives an indication of is maybe the age of the body with regards to environmental stressors.

WILSON: In other words, stress may be causing premature aging. It's not a popular theory, but he says, in part, it may come down to simply being black in America.

Dr. JONES: It could be induced in terms of discrimination and perceived discrimination. It could be due to living in an environment that produces stress. You know, all the things that are going on in Chicago with, you know, kids being killed. Well, that adds stress - community stress.

WILSON: Even after adjustments are made for education, poverty and other factors, the mortality rate remains high. Studies suggest that African-American women don't get screened for breast cancer as often as white women, and when they do it is later in life. Often, the mammograms are not routine screening mammograms, but rather they're done because the woman or her doctor felt a mass in her breast. They usually show up at surgeon Regina Hampton's office with the mammogram in hand.

Dr. REGINA HAMPTON (Surgeon): I certainly have women that come into my office that had a mass, and because of their young age, many health practitioners still don't believe that a young woman can get breast cancer. These cancers are there, and once they come to me, are found at a later stage. Then we're kind of running behind the eight ball trying to get the patient treated.

WILSON: There are also questions about the care that African-American women receive, whether they are referred to cancer specialists in a timely way and understand that they will need therapy after surgery. With all the issues surrounding black women and breast cancer, some health professionals say they should get mammograms earlier and more frequently.

The question for Georgetown's Vanessa Sheppard is whether starting at 40 is good enough.

Dr. SHEPPARD: The tumors are growing fast, and the intervals that we prescribe may not work. And so how can we have better diagnostic tools, how can we have better screening tools that can capture the women that aren't the average woman?

WILSON: It's a challenge many African-American women will have to come to grips with. About a third of them are younger than 50 years of age when they get breast cancer.

Brenda Wilson, NPR News.

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