Health News Review

For the past 24 hours I’ve squirmed about whether to or how to criticize NBC’s Andrea Mitchell about her on-air announcement of her breast cancer diagnosis and treatment. How can you criticize someone who is dealing with what she – and so many other women – are dealing with? But it’s now clear that some breast cancer survivors and others who know the science are critical of the message as well.

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All I am criticizing is the framing of her message. It appeared to be scripted and that script could have used some help. I have always had great respect for Ms. Mitchell as a journalist and wish her the best in her cancer treatment.

But when journalists use their national television platform to make health care claims or to give advice, those claims and that advice should be scrutinized.

Today a breast cancer survivor-blogger criticized part of what Ms. Mitchell said on the air, which was:

“For you women out there and for the men who love you, screening matters. Do it. This disease can be completely curable if you find it at the right time.”

Katherine O’Brien, of the ihatebreastcancer blog wrote:

“Early detection is not a cure. …”Completely curable” is a like a fat man wearing a hockey jersey. It covers a lot of ground. You have access to the top medical experts in the world-ask them what “cured” means in the setting of breast cancer.”

On Twitter, breast cancer survivor Katie Ford Hall of the UneasyPink blog wrote to Ms. Mitchell:

“Wishing you the best Ms Mitchell. When you feel settled, I’d love to talk 2 you abt the realities of bc “caught early” … What you said about breast cancer is harmful and untrue. You should correct it immediately.”

I heard from several other expert breast cancer observers yesterday with concerns about what Mitchell said on the air.

One pointed out the misuse of the overused “1 in 8″ statistic, as when she said:

“I am now among the 1 in 8 women in this country — incredibly 1 in 8 — who have had breast cancer.”

As the National Cancer Institute explains thoroughly on its website:

Women born now have an average risk of 12.2 percent (often expressed as “1 in 8″) of being diagnosed with breast cancer at some time in their lives. On the other hand, the chance that they will never have breast cancer is 87.8 percent (expressed as “7 in 8″).

But that is a lifetime risk. Risk increases with age, so the NCI provides a more helpful way of looking at it – for all of those women watching who are of different ages:

A woman’s chance of being diagnosed with breast cancer is:

from age 30 through age 39 . . . . . . 0.43 percent (often expressed as “1 in 233″)
from age 40 through age 49 . . . . . . 1.45 percent (often expressed as “1 in 69″)
from age 50 through age 59 . . . . . . 2.38 percent (often expressed as “1 in 42″)
from age 60 through age 69 . . . . . . 3.45 percent (often expressed as “1 in 29″)

Do you see how misleading the “1 in 8″ can be?

How could Ms. Mitchell have handled the message in a better way? I’d like to hear someone at a time like this – if they say anything – say something like this:

And now a personal note.

I don’t believe that journalists’ personal lives should become part of stories, but I am making this announcement to avoid the possible spread of any rumors or misinformation.

I’ve been diagnosed with and treated for breast cancer. I’m confident in my course of treatment but I don’t wish to discuss details because my case may not be representative of what other women face. My decisions are mine and should not influence others just because I’m on TV.

As you can see, I’m already back at work and have been told my prognosis is terrific.

(Her ending about being grateful to physicians, nurses, family and co-workers could remain the same)

Let me reiterate: I wish Ms. Mitchell all the best. As she moves forward as a breast cancer survivor, perhaps she will take some of these criticisms of the message to heart.

Comments

Holly Anderson posted on September 8, 2011 at 1:11 pm

Amen.

Katie posted on September 8, 2011 at 1:14 pm

Thank you for writing this Gary. It is indeed a sensitive topic. As a journalist, I want her to be able to embrace and explain a complicated story rather than relying on overused (and untrue) statements, like breast cancer caught early is curable, or that mammograms even catch breast cancer “early.”
Katie

Deb Boyce posted on September 8, 2011 at 1:52 pm

I certainly agree with the breast cancer survivors you’ve quoted! Early detection and early treatment does not equal a “cure.” From what I’ve seen, breast cancer is one of the most insidious cancers. Even if “caught early” it can recur 10, 15, 20 years later, sad to say.
Many thanks for taking this issue on and reminding those who are regularly featured in news broadcasts of their role and responsibilities as journalists.

Gregory D. Pawelski posted on September 8, 2011 at 2:31 pm

Ditto the Amen!

Ann MacMillan posted on September 8, 2011 at 2:33 pm

Thank you so much for addressing this sensitive topic so well, and so eloquently. As a 3 yr. breast cancer survivor, it is of vital importance to me, now that numerous organizations have brought about awareness of breast cancer, that we move on to focus on metastatic bc. We must now focus on preventing recurrence and a cure.
Thank you again,
Ann

Katherine OBrien posted on September 8, 2011 at 2:48 pm

Hi Gary
Thanks for the shout out.
I liked your proposed statement.
For reference purposes, here is what Natl Breast Cancer Coalition says, which may help others understand the “cure” issue:
Truth #4: When breast cancer shows up on a mammogram, it may have been in your body for 6-10 years
TRUE. What is early detection? We probably think of it as early enough to intervene and save a life. But there are different kinds of breast cancer. For some of them, if they are surgically removed, the breast cancer has been effectively “cured.” For others, it can be found really early, yet no known intervention will “cure” it. Complicated? Yes. But the truth about breast cancer is just that.

Trudi posted on September 8, 2011 at 3:02 pm

Thanks so much, Gary. Someone has needed to say these things for a long time, and maybe this is the least hurtful time and place to say them, given the positive nature of Andrea Mitchell’s prognosis.
I too had a good prognosis, and I’ve been fine after treatment. But I feel I learned more accurate factual information from my surgical oncologist than I see repeated over and over in the media and then parroted by the public.
When Elizabeth Edwards’ cancer recurred, for example, most stories in the media reported that it was now “incurable” or “now, no longer curable” because it had metastasized. This was so misleading. Cancer is never curable, even before it spreads. So many times, the media and the general public equate “successful treatment” of cancer, or a lengthy remission-free period, with “cure.” Members of the media, especially, have an obligation to share the truth about cancer with the public–that “remission” does not equal “cure” and “early detection” does not equal “prevention”–not so they’ll become scared, but so they’ll know what they’re dealing with.

Pink Ribbon Blues posted on September 8, 2011 at 3:53 pm

Dear Gary,
I was very concerned and disheartened when I saw Andrea Mitchell’s breast cancer ‘reveal.’ It is irresponsible for celebrity survivors to use their platforms to present their personal experience as Truth. One data point does not constitute a trend. Ever. Public health strategies cannot rely on single cases to establish health protocols, and journalists should not use single cases (including their own) as a proxy for evidence.
It was especially unconscionable to state – in the midst of ongoing and heated controversy over the benefits and limitations of mammography screening – that “her breast cancer was found during her annual screening,” that it was at its” earliest stage,” and that it had “not spread” as a means for substantiating her strict directive to “you women out there, and…the men that love you” that “screening matters. Do it. This disease can be completely curable if you find it at the right time.” Commanding other women to act as she did does not promote informed decision making. It promotes blindly following the leader of the pack. As for the heterosexist aspect of her comment, this was also unskillful.
And your other commenters are also right on in terms of what ‘early’ means in terms of breast cancer. Recurrences happen 20-30 percent of the time regardless of stage at diagnosis. Molecular biology trumps staging. Researchers know that. The Chief Medical Office of the American Cancer Society, Dr. Otis Brawley, knows that. Journalists ought to know it.
Thank you for demanding better of journalism.
Gayle Sulik

Marjorie posted on September 8, 2011 at 5:41 pm

I also cringed when I viewed this message. Thank you for this!

Deanna Attai posted on September 8, 2011 at 10:29 pm

Thank you Gary for this post. Not to take away from the importance of early detection (which leads in many but not all cases to improved survival), but to make the assumption of being “cured” based on early detection is unfortunately, wrong. We all know patients who were diagnosed in an early stage, only to develop a local recurrence, new primary lesion, or metastatic disease later. As was mentioned by Gayle, biology trumps staging. We try to have a positive outlook based on the success rates of treating early-stage disease, but the reality is that cancer is unpredictable, and continued surveillance and vigilance is important. I also like your “corrected” post – anyone going public with their early-stage diagnosis (and especially journalists, celebrities, etc) should take this as their script.
Deanna Attai

Lynn M. posted on September 9, 2011 at 6:56 am

Thank you! Let us focus on metastatic breast cancer as that is the killer! Those “survivors” of breast cancer were not going to die! They were most likely never going to be metastatic. It is metastatic breast cancer that needs research, funds and a cure. It is metastatic breast cancer that is incurable. We need a cure now for metastatic breast cancer and a cure for those that will become metastatic.

Felicia Hodges posted on September 9, 2011 at 7:27 am

Wow. Thanks for this post, Gary. I’m a journalist and soon-to-be seven years out of treatment but her assumptions and generalizations scared the crap out of me. But the truth would scare the crap out of the general public who likes happy endings and rosy outlooks. It’s the “happy pink” thing all over again. Don’t cha know BC is positive, cute and curable? Someday, journalist will present a truer picture about the realities of the disease, but, sadly, today is not that day. My hope is that as Ms. Mitchell learns more from her own experience (or by us showing her your post and these wonderful comments), she will be again in front of the cameras telling it like it really is. One can dream, right?

RWH posted on September 9, 2011 at 9:29 am

Gary, thanks for addressing the misinformation in Andrea Mitchell’s on air statement, sensitively and objectively. I wish Ms Mitchell a successful course of treatment. As others have posted, and in my experience as a cancer researcher, preventing metastases is what survival boils down to. Another thing that I never see promulgated in the media is that cancer is a systemic disease. While there may be local conditions that lead to a cancer in one organ/location in the body versus another, removing or treating a cancer locally rarely changes the systemic conditions that gave rise to it. However, cancer can (rarely) be cured, i.e. there is no subsequent recurrence or spread and a normal lifespan follows, if the body’s own immune system overcomes the cancer. The challenge for medical research and treatment is how to make that happen. There have been a few hints in recent years, but unfortunately nothing yet that can be widely adopted clinically.

kathi apostolidis posted on September 9, 2011 at 2:24 pm

Congratulations to the survivors and patients who did not let this statement go without attention to details and thanks to you Gary for taking them up and commenting. October approaches and we will hear a lot of fads repeated in diapason like this one about early detection or monthly breast self-exam or yearly mammography for all women…
Breast cancer is a serious issue and public messages should be scrutinized beforehand..

Lisa Collier Cool posted on September 11, 2011 at 12:00 pm

As an award-winning health writer who is also a cancer survivor, I disagree with the script you have written for Andrea Mitchell that has her saying that journalists shouldn’t be part of the story by revealing their cancer diagnoses. Yes, there was a time when women didn’t talk about breast cancer, causing those with the disease to feel very alone in their battle with a potentially fatal disease, but I’d hate to see a return to the time when women felt they had to hide in the closet with this disease.
When prominent people, including TV reporters, speak out about their battles with breast and other types of cancers, I feel that discussion is actually extremely beneficial by encouraging women to take the best possible care of their health, such as getting recommended screenings like mammograms, which American College of Obstetricians and Gynecology and American Cancer Society advise annually, starting at age 40. Therefore, although in the stress of getting a potentially life-threatening diagnosis, Andrea Mitchell did misstate a statistic, I believe that overall, she has performed an important service that could help save lives and feel that she should be commended rather than criticized for that,

Gary Schwitzer posted on September 11, 2011 at 1:07 pm

There is nothing in what I – or the 14 others who at this point have left comments in agreement with me – wrote that can be construed as a suggestion that “women should have to hide in the closet with this disease.” Indeed, many of the 14 other prior commenters are women with breast cancer who are actively using social media to talk openly and often about their disease. In fact, many of these women who have left comments can be considered leaders in use of social media to effect improved public understanding and discussion of breast cancer issues.
And, indeed, what I wrote was a suggestion for how the message could have been handled better – not a call for her diagnosis not to have been revealed at all.
That is what resonated with these other commenters. I’m sorry that it didn’t resonate with you in the same way.
GS

Lisa Collier Cool posted on September 11, 2011 at 9:39 pm

Hi Gary,
I was referring to the part of your script for Andrea in which you had her saying that she didn’t believe journalists’ personal lives should be part of stories, which sounds like you’re saying that in your opinion, she shouldn’t talk about her breast cancer diagnosis or give any details about it on the air. That would have the effect of silencing her, just as women silenced themselves in the past due to shame and fears about this disease. But fortunately, she doesn’t believe any such thing and is trying to help others by shining a light on this disease and the value of screening.
Re the other writers who are sharing their breast cancer stories in their blogs or other media, which I totally support, do you feel they also shouldn’t let their personal lives be part of the story and shouldn’t talk about any details of their cases since they may not be representative of other women’s cases (as the script you wrote for Andrea has her telling her viewers)? And if not, why do you impose a gag rule that silences Andrea from sharing her breast cancer story that don’t, in your opinion, apply to any other writers, bloggers and reporters with breast cancer?

Gary Schwitzer posted on September 12, 2011 at 7:40 am

Once again, I restate what I reminded you in my last response: what I wrote in my original post was a suggestion for how the message could have been handled better – not a call for her diagnosis not to have been revealed at all. I never wrote a thing about “silencing her.” I never “imposed a gag rule.” Please don’t read into things what I did not write and what I did not intend.
Regarding your second point, you miss two HUGE differences between Ms. Mitchell and the 14 or so other voices that have weighed in on my blog.
• Ms. Mitchell has a national (international?) television platform. The power of that platform is abused when misstatements are made. The women who left comments on my blog have no such national platform. They disagree with the way that platform was used in this case. They have adopted social media formats – blogs, Twitter, Facebook – to attempt to find some way of countering misinformation that they see disseminated in mainstream media channels. That is why they reacted the way they did to Ms. Mitchell’s on-air network television statements.
• Ms. Mitchell is a journalist. The difference between a journalist giving opinions on national TV and women with breast cancer writing on their personal blogs should be clear to any reasonable person. You can read above how some women with breast cancer reacted to Ms. Mitchell’s advocacy comment: “For you women out there and for the men who love you, screening matters. Do it. This disease can be completely curable if you find it at the right time.” Journalists need to understand the depth of unhappiness that many women with breast cancer have – as health care consumers and as news consumers – with the ways in which breast cancer stories are told by many mainstream media. This is – to a large degree – for many of them – one of the main reasons they blog and tweet and use social media.
If you can’t appreciate this, there’s not much I can do to make it more clear in an online exchange. We’ve now exchanged 9 messages via email or comments left on this website or on the MedPage Today site – http://www.medpagetoday.com/Blogs/28416 – which also published my article. I don’t want to have to keep repeating the same things over and over. So I’m going to suggest and offer that perhaps you and I could discuss this in person or by phone sometime. It’s just not practical for me to keep responding online when I think we’re covering the same ground.

Katherine OBrien posted on September 12, 2011 at 10:33 am

To Lisa Collier Cool:
I am a trade journalist.
Comparing myself to Andrea Mitchell a national television corespondent would be like saying someone who owns a first aid kit is a doctor.
Nonetheless, a platform is a platform. I am both a journalist and a breast cancer blogger. I have shared my story personally–on my own blog and on my own time. Because I am a journalist, I have taken pains–just as I would with any story I report–to be concise, accurate, and as Strunk & White preach, omit needless words. “Avoid ambiguity” is right up there with “If your mother says she loves you, check it out.”
I serve a small (and unfortunately shrinking industry). Because I have been in this niche for 14 years, the line is often blurred between my personal and professional life.
But not in print.
I was diagnosed with breast cancer in 2009, shortly before the industry’s largest annual trade show. Meeting are set weeks in advance. I was originally told I would have chemotherapy. I had to tell colleagues and others in the industry I wouldn’t be a the show and arrange for others to cover my responsibilities.
My mets were discovered a couple of weeks after the initial dx. Having to tell people I had breast cancer and then, having to go back and tell some of them that I had metasttatic disease (Stage IV, incurable, take your pick) was like dying twice. It was horrible.
My question would be: Andrea Mitchell suggested her treatment has concluded. If she had presumably DCIS, why did she feel it necessary to make a public announcement apparently only one week after her diagnosis?
Do you think it was founded out of sincere gratitude to friends, family and physicians? A zealous desire to save other women from her fate? Could professional considerations have played a role? Was Andrea Mitchell also providing reassurance to her employers as well as the advertisers that bought a schedule of sponsorships based on her participation in the broadcast? Those latter issues were not concerns for me.
The one thing I would say to any newly diagnosed woman: How you fell now is not likely how you will feel a few weeks later. I would suggest giving yourself time to wrap your head around the diagnosis (and educate yourself on the disease) before making public statements (especially if those statements are beamed to millions across the nation).

Christine Norton posted on September 12, 2011 at 11:30 am

As a 21 year breast cancer survivor, I believe Lisa Collier Cool is twisting & misinterpreting Gary Schwitzer’s words. There is nothing in Gary’s blog or suggested language that indicates Ms Mitchell should have to hide in the closet & not mention her breast cancer.
Many other breast cancer survivors have left posts that pointed out aspects of Ms Mitchell’s on-air statement that aren’t appropriate for a journalist. Like so many others, Ms Mitchell erroneously equates an early stage diagosis with “being cured.” Ms Mitchell’s advice that women be screened can easily lead to over-diagnosis and over-treatment. It would have been much better if Ms Mitchell had urged women to be part of an informed screening decision with their health care professional.
Since decades of “breast cancer awareness” and the “sea of pink” have not brought a cure for breast cancer or even a way to prevent breast cancer, it is definitely time to Change the Conversation. Be part of BreastCancerDeadline2020.org & take action to find a way to prevent breast cancer & end metastasis.

Gregory D. Pawelski posted on September 12, 2011 at 11:39 am

I’d like to present the same comment I left on MedPage Today, here. All Gary is doing is criticizing the framing of Ms. Mitchell’s message. The message he is giving is that people in the news media need to become more retrospective in their role in delivering to the public, accurate, complete and balanced messages. The media needs to produce coverage more in line with their responsibilities. And those responsibilities are not to sensationalize events, even those which are personal in nature. A television journalist can influence the behavior of clinicians and patients. As a seasoned reporter, Ms. Michell’s message should have been detached from her personal feelings. I too, convey my best wishes to Ms. Mitchell’s recovery, with hopes of lasting success. But Gary’s message was about the message being conveyed.

Pink Ribbon Blues posted on September 12, 2011 at 5:34 pm

Given the wealth of comments that the critique of Andrea Mitchell’s announcement generated, I felt the need to articulate my own concerns about her breast cancer ‘reveal’ in a more systematic way.
Here is, “A Call For Responsible Reporting.”
http://gaylesulik.com/2011/09/a-call-for-responsible-reporting/
Sincerely,
Gayle Sulik, M.A., Ph.D.

Iwillwinthisbattle posted on September 15, 2011 at 11:12 am

It is time to stop preaching awareness and start focusing ALL of our efforts on treatment and cure of this horrible disease. I encourage everyone to do whatever they can to let the companies who are on the “find the cure” bandwagon to divert their funds to the places that are working on actually researching a cure for metastatic breast cancer. I believe they will respond if enough public pressure is put on them. We can make a difference!

Pat Frappier posted on September 15, 2011 at 11:22 am

Thank you! Media needs to be very careful as to what they are trying to convey. They definately need to check and re-check their facts. I’m am someone who had “early” check-ups, yet was still diagnosed with Stage IV Breast Cancer (initial diagnosis)several “clear” mamograms later at the ripe old age of 49.

peggy connora posted on October 6, 2011 at 5:02 am

I am one of millions of people (yes, men get breast cancer too) who was treated in 2004 for breast cancer with chemotherapy and radiation. i never was told that i was cured, but we hoped for the best. 5 years later my cancer became metastisized, spread to my bones and i am receiving treatments and hoping for the best. this is incurable and stage 4, but can be managed for my lifetime. Everyone should know that breast cancer is a chronic disease . The big lesson of the story is that every hour, every day counts and that living each day healthfully and meaningfully is the best you can do.