The Saint Paul Pioneer Press published an editorial I wrote in response to one of their recent news stories. I appreciate being given that forum. Unfortunately, their online version did not include the hyperlinks I provided. So I have republished the editorial here, complete with links:
It sounded so inviting, so harmless, so caring.
But it was so incomplete, imbalanced, and even potentially harmful for some readers.
When the Pioneer Press reported “Hastings hospital’s mammogram parties offer women a dose of pampering to calm the nerves (January 19, 2011),” it quoted two different hospital marketing people promoting their “Mingle & Mammograms” parties. The story described pampering, appetizers, chocolate, sparking cider or wine, flowers, swag bags, massages, foot reflexology, and cuticle paraffin treatments.
But in a 1,000-word story, fewer than 100 words even hinted that there is important scientific disagreement about mammography. More than twice as many words were devoted to what marketing people said. There was not one word about the very real tradeoff between benefits and harms of mammography for women in their 40s.
Here are some perspectives missing from such news and such promotions.
Dartmouth’s Dr. Gil Welch (author of “Should I Be Tested For Cancer? Maybe Not, And Here’s Why”) wrote about mammography in a medical journal: “The question is no longer whether overdiagnosis occurs, but how often it occurs.” He included the following table to explain the tradeoffs of harms and benefits (debits and credits) – and this was for 50-year old women, for whom the evidence of benefit is stronger than it is for those in their 40s.
Welch explains, “The benefit of breast cancer screening is that some breast cancer deaths can be avoided. Unfortunately, it doesn’t happen very often: most women destined to die from breast cancer, will still do so – even if they are regularly screened.” So while in 1 in 1,000 benefits, the other 999 would be screened for 10 years and gain nothing. Some, as shown, are harmed.
Dr. Laura Esserman, director of the breast care center at the University of California San Francisco, co-authored a journal article, “Rethinking Screening for Breast Cancer and Prostate Cancer.” Excerpt:
“After 2½ decades of screening for breast and prostate cancer, conclusions are troubling: Overall cancer rates are higher, many more patients are being treated, and the absolute incidence of aggressive or later-stage disease has not been significantly decreased. Screening has had some effect, but it comes at significant cost, including overdiagnosis, overtreatment, and complications of therapy.”
Dr. Danielle Ofri, an NYU professor of medicine, wrote a column, “The Engine of Cancer Screening Rolls On.” Excerpt:
“There are all sorts of commercial entities that stand to gain with an aggressive indiscriminate screening message. Mammography is a big business. Imagine a high-tech product (iPhone or Android for example) that 25 percent of the population needs to purchase every single year. Somebody, somewhere, is raking in boatloads of money.
Unfortunately, conveying nuance and uncertainty is not a strong suit of the media, the public discourse, or doctors, for that matter. Everyone wants clear, definitive answers from a situation that will never be able to offer one.
But complex, imperfect scientific facts rarely translate into sexy poster slogans.”
Indeed, the marketing of other screening tests has upset officials of the American Cancer Society. Dr. Otis Brawley said on a YouTube video:
“I’m very concerned. There’s a lot of publicity out there – some of it by people who want to make money by recruiting patients – that oversimplifies this – that says that ‘prostate cancer screening clearly saves lives.’ That is a lie. We don’t know that for sure… We’re not against prostate cancer screening. We’re against a man being duped and deceived into getting prostate cancer screening.”
The Cancer Society also criticized the marketing of CT scans for smokers after results of the National Lung Screening Trial were released. Excerpt:
“…although enormously promising, the data was not enough to call for routine use of this screening test …But our greatest fear was that forces with an economic interest in the test would sidestep the scientific process and use the release of the data to start promoting CT scans. Frankly, even we are surprised how quickly that has happened.”
Too often, conflicted parties exaggerate the benefits of screening tests and minimize or ignore completely the harms, the uncertainties, or the lack of evidence. They make screening decisions sound simple. They are not and should not be.
There are intelligent, informed people who say “no” to screening. You’d never know it from hospital marketing messages promoting “Mingle & Mammogram” events. We don’t usually hear from them in news stories. I know a nurse practitioner – an intelligent health care provider – who has written about why she will no longer have mammograms – even though her sister died of breast cancer.
This is not meant to discourage anyone from screening. It’s a call for accurate, balanced and complete information on screening to help people make informed choices.
That would be something to celebrate.