African American women are more often diagnosed with breast cancer at ages younger than 50, have lower mammography screening rates, have higher breast cancer mortality rates, and more advanced stage at breast tumor diagnoses, than other women. Early detection through mammography screening is important in decreasing mortality. The revised United States Preventive Services Task Force (USPSTF) breast cancer screening guidelines, however, make no recommendation for routine mammography screening in women aged 40-49 years. Given the well-documented disparities experienced by several underrepresented populations, especially African American women, this recommendation has raised concerns among the public and medical community. The 2009 USPSTF breast cancer screening guidelines should be modified to take into account populations with different profiles that put them at higher risk. This commentary describes the burden of breast cancer among African American women and identifies issues with the current USPSTF guidelines that have the potential to uniquely impact African American women and increase breast cancer disparities. This commentary concludes with recommendations for future directions.