First, I sincerely wish ABC’s Amy Robach good health and good outcomes after she chose to have a mammogram on the air and, after it showed that she had cancer, further chose to have bilateral mastectomy surgery. These are difficult choices and difficult times for her.
But almost every single one of the hundreds of news stories and web articles about her case have been shallow and incomplete.
There are some problems with her announcement – both in terms of the inferences made to other women and in terms of journalism ethics.
First, the message to other women.
I haven’t seen any report of what her mammogram actually showed. And what did the biopsy that followed the mammogram show?
Normally, I’d say that’s none of our business.
But when a network TV personality says the mammogram saved her life, that changes the discussion. If you’re going to use that national television platform to announce your choices and to make claims about what a mammogram did for you and how it might inspire other women, then we should at least know more about the pathology of your cancer – something, as I already said, I normally would say is none of our business.
As I am drafting this, I just now see that noted breast cancer expert Dr. Susan Love has written much the same thing – before I could complete my post and get it published. She wrote:
“Did the mammogram save her life, as one doctor was quoted as saying? The answer, of course, is we don’t know. While mammography is capable of finding about 26% of cancers at a point where it makes a life-saving difference in the outcome, it also finds many lesions which would never have gone on to be life-threatening and others which will still be life-threatening in spite of early detection and rigorous screening.
The problem is not the mammogram as a detection tool, but the natural history of the disease, which brings us to the crucial point…not all breast cancers are the same. Before a treatment is prescribed or chosen, it is critical that a woman or man knows what kind of breast cancer they have of the roughly 5-7 kinds we can now recognize. There are probably many more kinds that we just don’t know about or know how to recognize yet. The behavior of the cancer is dictated not as much by when it is found as by what kind it is and how that kind usually behaves. This information informs the decisions about treatment. …
We all need to help tone down the hype that mammograms are the be-all/end-all life-saving tool and stop fueling mass fear that a questionable mammogram is a potential death sentence.”
So while many statements have already been made about how and why Ms. Robach’s story might influence other women, there is this other side to consider. There are potential harms from mammography, whether a woman chooses to consider those or not. They are clear. They are reported. There are data to show how often they occur.
Now the journalism ethics.
I believe it is unethical for network television journalists to use their celebrity status to talk about their own health care decisions and to suggest what other people should do.
I’ve written about some journalists’ unhealthy advocacy of various screening tests for years. I thought it was wrong and I wrote about it when:
(Anyone see an NBC pattern here?)
There are countless other examples – especially on local TV news. And there are some in print. But the national television platform is still influential – and is used, in my opinion, unethically when it delivers an advocacy, opinion-based message on what should be a highly-individualized, evidence-based, shared decision-making discussion between patient and doctor.
Please don’t write to me accusing me of being anti-screening. That will only show that you didn’t read this piece. This is not anti-screening. This is about discussing the known tradeoffs between potential benefits and potential harms in mammography. And it’s about journalists sticking to facts, not offering opinions, advice, or their own personal stories in ways that are meant to influence others’ decisions or even in ways that might potentially have that impact.
Addendum on November 18:
Also see these pieces published after we posted ours:
Addendum on December 10: Gayle Sulik, Ph,D, author of Pink Ribbon Blues, wrote on Psychology Today, “Amy Robach Story Spreads Heartfelt Misinformation: Plain Truths about breast cancer lost in mythology and wishful thinking.”
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