I am reluctant to use the word “racism”, but sometimes you have to call a spade a spade. There is a systemic form of racism involved in over-weighting these ancient RCTs that were performed on a group, 98% of which were white women.
When you put those at the top of the evidence hierarchy or the top of the pyramid, you are systematically leaving out every other race. Women who are white have a peak in breast cancer in their fifties to sixties. Every other race that's not white gets their peak in their forties. In this question, we are specifically focused on women screening in their forties. Every race other than white has been excluded in their highest level of evidence. Yes, there's a systemic form of racism there.
I was dismayed to see in the guideline that they acknowledge there is a higher mortality rate for Black women. Black women have a slightly lower chance of getting breast cancer, but when they do, they are 40% more likely to die of breast cancer. They acknowledge that, but they put them in the average-risk category, which is the category where they don't get screened in their forties, or there's no strong recommendation for them to screen in their forties. You have this double whammy of people being more likely to die if they get breast cancer and being in a group that is under-investigated, understudied, so you have this systemic form of racism. I don't call it personal racism. I'm sure there's no intent to be racist, but if you disregard these racial imbalances in the research, then you have entered systemic racism.