Health News Review

A well-intentioned ad campaign run by the American Cancer Society is too vague, and, therefore, may leave impressions that are imbalanced, incomplete and unsubstantiated – the kind of common tactic seen in many drug company ads.

That’s my opinion based on my analysis of the ad and based on my reading of the text.

A Cancer Society news release states:

The American Cancer Society Cancer Action Network (ACS CAN) is launching a new print and online advertising campaign in congressional districts across the country this week, urging lawmakers to fully fund a lifesaving cancer prevention, early detection and diagnostic program that is celebrating 20 years of screening low income, uninsured, and medically underserved women for breast and cervical cancer. The ads also send the message that when it comes to increasing your odds of surviving cancer, access to evidence-based early detection tools is critical.

The ads reference the Centers for Disease Control and Prevention’s (CDC) National Breast and Cervical Cancer Early Detection Program (NBCCEDP), which has a track record of reducing deaths from breast and cervical cancer. The program has provided more than 9 million screening exams to more than 3 million women and diagnosed more than 40,000 cases of breast cancer and more than 2,000 cases of cervical cancer since it launched in 1990. But with limited funding, the program is able to serve fewer than 1 in 5 eligible women.

The accomplishments of the CDC NBCCEDP are noteworthy. So this blog entry is no knock on that program.

It’s a criticism of the ad.

We can't fight cancer if we can't see it AD.jpg
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There is no specific mention of the specific goals of the CDC NBCCEDP. The ad doesn’t state what the news release states that this is promoting “20 years of screening low income, uninsured, and medically underserved women for breast and cervical cancer.”

Instead, the ad promotes unspecified screening – all screening, one could infer. “We can’t fight cancer if we can’t see it….When it comes to cancer, screening is seeing…It’s time to take the blindfolds off and stop cancer before it starts.” Catchy phrases from an ad agency or from someone creative at the Cancer Society. But are we talking about prostate cancer screening? Lung cancer CT scan screening? Ovarian cancer screening? Show me where it does NOT say that. And show me where it DOES say this was about breast & pap smear screening for medically underserved women?

But this is a fund raising and political message: “current funding isn’t enough…tell your members of Congress (to) increase funding…”

And when you’re raising funds, a little vague fear-mongering can’t hurt, right?

Wrong.

One other piece of copy from the ad demands scrutiny: “60% of cancer deaths could be prevented.” The implication is that’s all from screening because screening is the only prevention method mentioned in the ad. Nothing about stop smoking or other lifestyle changes. If the ad meant to imply that 60% of cancer deaths could be prevented just from screening, it should provide the evidence for that. If the ad did not mean to imply that, but was just misleadingly vague, then I call for the ACS to pull this ad. In either case, I think they have a problem.

That unsubstantiated 60% figure is especially ironic since the ACS news release includes this line: “Access to evidence-based prevention is just one component of the fight to defeat cancer.” We needed a little more clear evidence here – evidence that would show that screening is just one part of prevention.

Earlier this summer I criticized a federal agency’s vague screening promotion ads. I’ll end this note in a fashion similar to the way I ended that note:

I know that the folks at the American Cancer Society (or their ad agency) had their hearts in the right place with this campaign. But their heads have to do a better job of learning how to communicate about screening. Or else they’ll be guilty of the same disease-mongering techniques that are so prevalent in so many other messages in general circulation these days. The worried well are constantly whipped into a frenzy over the supposed weapons of mass destruction inside all of us. As a physician-colleague reminded me: “All screening tests cause harm; some may do good as well.”

You’d never know it from the ACS ad. But then again, it’s “only” a fundraising ad, right?

Comments

Elaine Schattner, M.D. posted on August 11, 2010 at 11:08 am

Yes, the ACS message is oversimplified. But it’s effective and, I think, essentially true. The ACS is not the enemy; they’ve directly helped millions of patients, provided support to caregivers and funded good research (with, by the way, a highly-competitive, peer-review process that far exceeds most other private foundations’ methods for deciding who gets grants).
As you know, I’m an oncologist who advocates breast cancer screening by digital mammography every other year for women over the age of 40. But I don’t support all screening programs blindly. Nor does the ACS.
In some circumstances, cancer screening does save lives. This is particularly true for breast and cervical cancers in women. Since the advent of mammography and adjuvant treatment for early-stage tumors, survival of women with BC has improved dramatically – beyond the degree that can be explained by lead-time bias. Even the Annals’ papers of last fall, around which the controversy arose, admitted a small survival benefit. The question was whether women could handle the fear/anxiety/discomfort/etc. of biopsies, and whether the process is cost-effective.

Gary Schwitzer posted on August 11, 2010 at 11:15 am

Elaine,
I respect your opinion and thank you for posting it here.
To clarify: I didn’t say the ACS was the enemy. I didn’t say the ACS supports all screening programs blindly. I did suggest that this vague ad may leave that impression with anyone who sees it.
And I did not say anything to negate your comment that: “In some circumstances, cancer screening does save lives.” But it is also true that screening tests can cause harm.
Gary Schwitzer
Publisher

AC posted on August 11, 2010 at 3:24 pm

I agree with you. The ad seems vague – what cancer screenings are they refering to in the ad copy? It’s too wide open. I think the American Cancer Society is doing a great job, but this ad seems pretty weak. Maybe it’s a generational thing for me, but the ad image made me think of the Hostage Crisis of 1979. The ad’s just not working for me. bummer, they missed a good opportunity to make a strong point and failed.

Christie Aschwanden posted on August 11, 2010 at 5:05 pm

This isn’t the first time the ACS has published misleading ads.
http://www.nytimes.com/2007/07/10/health/10skin.html
Shame on them for perpetuating the idea that those who die of cancer could have been saved if only they’d been screened sooner or better. While that may be true for a small subset, it’s not true for everyone and this notion causes great anguish to those diagnosed.
I will never forget a mother I interviewed years ago for a magazine article. She was convinced she had killed her daughter by allowing her to be in the sun as a child. (The daughter had died of melanoma in her teens or 20′s.) A sad story, and completely unproven.
Truth should not be sacrificed to raise money.
–Christie

Paul Scott posted on August 12, 2010 at 9:28 am

The notion that we know which breast cancer tumors are likely to worsen and which are not is unproven, if I am not mistaken. The notion that cancer begins as a local disease that then becomes mobile — essentially the framework for a paradigm of ‘catching it early” — is rooted in the 19th century turn towards surgical excisions. That move was amplified in the 20th century proliferation of imaging and “early detection” technologies, the modern makers of whom — GE and others–no doubt helped underwrite this expensive ACS campaign you discuss.
And the reduction of mortality from early detection of breast cancer seems in question as well — according to the medical historian Robert Aaronowitz, deaths remained stabile at 28 per 100,000 from 1950 to 1990 a period of explosive growth in mammogram screening.(see link below) The gains made prior to that seem to have been related to the identification of more non-fatal tumors.
I would cut the ACS more slack for having their “heart in the right place” were they not actively and horrendously attempting to discredit the science of environmental causes of cancer, including from cell phones. They do not wish to offend their corporate sponsors by calling for less cancer, which is surely their right, but to see the ACS’s Otis Brawley and others treating the science of environmental cancer so dismissively, and to have watched the larger organizational opposition from the ACS to the president’s panel on environmental cancer is really quite disturbing.I think it is an organization that is ideological more than scientific — it does not question its model or its funding and does not trust science that doesn’t fit its convenient focus on early detection.
http://www.nytimes.com/2009/11/20/opinion/20aronowitz.html?_r=1&pagewanted=2

Dawn Glossa posted on August 12, 2010 at 3:16 pm

It’s an ad. Which is meant to make people look further, do something. An ad can’t tell the person everything…then it becomes a brochure. If the ad lead people to a place without the deeper information, then I would say you have a point. But it does lead them to the right place to find out the exacts.
Respectfully,
DMG

KittyKitty7555 posted on August 12, 2010 at 6:56 pm

The American Cancer Society has its heart in your wallet. They are the richest “nonprofit” ever – they take in something like half a billion a year. And I hope that all those “low income, uninsured, and medically underserved women” who are the targets of their screening screed are informed of the risks of BC screening beforehand. Like the risk that they will be diagnosed with cancer when they have a non-progressive condition. Even the National Cancer Institute now admits that, “Approximately 33% of breast cancers detected by screening mammograms represent overdiagnosis”.
Please see: http://www.cancer.gov/cancertopics/pdq/screening/breast/HealthProfessional/page2
They should also be told that BC screening greatly increases the chance that they will have a mastectomy, and OH the best part – it doesn’t make you any less likely to die. And can you imagine what it’s like to be diagnosed with BC when you’re poor and uninsured? Like they don’t have enough to worry about.
And Dr. Schattner, the ACS is not just oversimplifying their message. By pushing a potentially dangerous test and not informing women of the risks they face they are lying by omission. Oh sure, their heart is in the right place – just like those doctors who performed those syphilis experiments on poor black guys in Georgia way back when. I heard that they weren’t told about the risks either.

Adam Edelman, MD posted on August 14, 2010 at 6:50 am

I certainly agree that the ad was vague and reminiscent of those fear mongering ads we are used to. In 2008, in Indianapolis there were full size billboards at various locations by the highways that stated “Colonoscopy or CANCER”. This was sponsored by one of the local health systems. This may be the ultimate example. Thanks for your good work.