Health News Review

Another hospital claims a “first,” and another local newspaper bites on the bait, writing a story that is devoid of evidence but filled with one woman’s “success story.”  That’s just part of what bugged Theresa O’Brien when she read the story in her local paper.  Ms. O’Brien is a freelance technology and marketing analyst. She also writes a column, “Allentown Family Health Examiner” for her Lehigh Valley, Pennsylvania community. The following is her guest blog post.

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In 1985, the American Cancer Society and Imperial Chemical Industries — manufacturer of tamoxifen and precursor of AstraZeneca — declared October to be Breast Cancer Awareness Month, with the goal of promoting mammography.  Since that time, October has become a month of “pinkwashing,” with groups from the NFL to major newspapers to fast food purveyor KFC painting themselves pink to “raise awareness” of breast cancer and promote screening. Local newspapers, of course, are far from immune to the pinkwashing epidemic.

The lead article in the lifestyle section of the Easton Express-Times on October 6 (which actually looked like the front page to home delivery customers, because the lifestyle section is wrapped around the news section) shouted, “Once and (hopefully) done.” The online version of the article has a much more sane headline — “St. Luke’s new technology allows women to get radiation treatment during lumpectomy”; an image of the physical newspaper is provided below:

The happy patient is shown with her smiling doctor in a photo accompanying the article, which is a model of how not to do medical journalism. The gist of the story is that Sharlene Schoenen had early-stage breast cancer, which was treated (apparently successfully) with intraoperative radiation therapy (IORT). Coating that kernel of truth is a sticky layer of emotion on the part of the patient, which changes the article from a feature about a new therapy for a select group of breast cancer patients to a promotion for IORT, and by extension, for St. Luke’s Hospital, which offers it.

“The day after her lumpectomy, Sharlene Schoenen went out for dinner,” the article opens, and the quality of journalism goes downhill from there. “Her cancer treatment was over as quickly as it had begun,” the reporter states, ignoring published research indicating that for some women, whole-breast irradiation and even additional surgery are necessary subsequent to the IORT procedure. The reporter continues to quote the patient, noting that “She highly recommends the treatment to those who are candidates for it,” again ignoring a published scientific review whose authors assert that “there is still little information about the effectiveness of PBI [partial breast irradiation] via EBRT [external beam radiotherapy] or novel strategies like IORT, which therefore should preferably be investigated within trials.”

And it wouldn’t be breast cancer awareness month without a plug for annual mammography, a protocol still debated by researchers and clinicians — and seldom followed by female clinicians in their own personal medical care: “Years ago, Schoenen had a benign tumor removed from her breast after it, too, was spotted on a mammogram [...] ‘Get your mammogram every year,’ Schoenen says.” The jury is still out regarding the cost / benefit analysis of annual mammography, but the Express-Times reporter seems content to let 73-year-old Sharlene Schoenen have the last word.

Given that the patient may be biased toward recommending annual mammography and IORT because of her own “speedy, wonderful experience,” and given that Ms. Schoenen is neither a physician nor an epidemiologist, it seems remiss of the reporter not to provide any context for Ms. Schoenen’s advice. For example in the August 2013 issue of Cancer, a study summary states, “women aged 50 to 74 years who are screened every other year have a similar risk of advanced stage disease and a lower cumulative risk of false-positive results than those who are screened annually.” Women aged 40 to 49 years also have a lower cumulative risk of false-positive results if they elect for biennial rather than annual mammography.

Additionally, researchers in the UK report that although “It is widely believed [...] that regular follow-up with imaging is important for patients who have been treated for early breast cancer, [...] current evidence does not support this.” Perhaps most tellingly — and famously explored by statistician Gerd Gigerenzer in his book Gut Feelings — female physicians don’t practice what they preach regarding mammography. As demonstrated by the results of federally funded research, “Obstetricians and gynecologists tended to recommend early mammography screening to their patients, though their personal practices indicated later start than their own recommendations and lower frequency of screening than peers in recent studies have recommended.”

IORT may be a ground-breaking therapy for some women. Mammograms do detect cancer. However, articles that merely hype a technology and let an enthusiastic patient take over the reporting do a disservice to all potential patients.

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Comments

Bruce Parker posted on October 15, 2013 at 9:44 am

Gary: We engage in such convoluted half truths because they work: in medical advertising, in political wrangling over a budget where the hot buttons are debated, though these are often only tangentially related to the underlying goals of combatants. High profile conflict and relief from anxiety usually trump simple information. -Bruce Parker