Health News Review

A Systematic Assessment of Benefits and Risks to Guide Breast Cancer Screening Decisions” was published in the Journal of the American Medical Association this week. It reached a conclusion that you might think few could disagree with – although on this topic one should never underestimate the potential for disagreement.  The authors wrote:

“Mammography screening appears to be associated with reduced breast cancer mortality, but for some patients, the harms may outweigh the benefits. Until better screening methods are available, improved understanding of these harms, enhanced strategies to identify the highest-risk patients, and tools to help patients and clinicians incorporate these in their decisions should be research priorities.”

In an accompanying editorial, Drs. Joann Elmore and Barnett Kramer write that the “nuanced balance is not easily communicated.”  Indeed, they point out how federal government coverage policy may oversimplify the issue:

“With the goal of improving access to preventive services and medical screening, the Affordable Care Act (ACA) offers free screening mammography to women. However, women often pay for the consequences of screening, even if the screening examination is free. Women bear not only financial charges but also important human costs. Screening mammography can trigger recalls for more testing, biopsies, mastectomies, radiation, systemic therapy, days off work, and debt related to health care costs. These byproducts of screening can lead to adverse financial consequences and personal harm. ...Balanced messaging is essential to help each woman make her own individual decision regarding her participation in screening mammography. “

“Nuanced balance is not easily communicated.”  Certainly not in news headlines.

The Washington Post published a headline: “Despite strong benefits, mammograms may have greater harms than previously realized, study says.”  The story goes on to refer to “substantial” benefits. No reference to “strong” or “substantial” benefits appears anywhere in the JAMA article in question.  The story goes on to quote one of the authors of the study, saying:

“The data that we have are not perfect, and they are mixed. But they do strongly suggest that ­although mammography does have benefits, it does also have a lot of harms, and those harms are not insubstantial.”

” It is “profoundly disappointing that mammography doesn’t quite live up to its promise…it does not show as strong a benefit as is often suggested in the media.”

Strong and substantial versus profoundly disappointing and not as strong as suggested in the media – in the same story!  No, nuanced balance is not easily communicated.

A Hawaii TV station’s story boldly stated, “Mammogram benefits outweigh risks, new study says.” Which study was that?  No, nuanced balance is not easily communicated.

Meantime, as just one little glimpse of how special interests are in a battle for the hearts and minds of American women – and for the hearts and minds of journalists – on the mammography issue, The Society of Breast Imaging – the people who have a vested interest in mammography – paid to have an exhibit at the Association of Health Care Journalists conference in Denver last week.  The Association states that it “seeks to minimize the possibility and appearance of inappropriate influence from outside parties,” but that “a very limited number of organizations in this category (not-for-profit associations or societies that represent those who sell health care services or who lobby legislators on health care issues) will be allowed to exhibit at the annual conference.”  Below is a photo of Dr. Daniel Kopans making a point to a journalist who walked by the exhibit.

In response to the new study,  The Society of Breast Imaging issued a news release, “JAMA Article Breast Cancer Screening Recommendations Potentially Deadly for Many Women.” But the JAMA article was a review of the evidence, and didn’t make any direct recommendations about screening.  Rather, it focused on individualizing decisions based on patients’ risk profiles and preferences, and on an improved understanding of potential harms.

No, nuanced balance is not easily communicated.

In a past statement of “facts about mammography screening” on the Society of Breast Imaging website, Dr. Kopans gave advice to women over 40:

“Obviously, it is your decision, but I recommend that you have a mammogram every year as long as you are in good health and would have treatment if a cancer is found.”

That is a recommendation. Nuanced balance?  You be the judge.

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Comments

Brad F posted on April 3, 2014 at 7:13 pm

Gary
Thanks for unwrapping the stealth and continuing to reveal the nuance–only experienced eyes can spot in an instant.

For those who want to learn, your (unfunded) blogging makes a big difference. Keep it up.

Brad

Thomas posted on April 3, 2014 at 9:29 pm

A lack of “nuanced balance” regarding mammography is no surprise.

The history of mammography is almost totally devoid of “nuanced balance”, whether in the reporting of the mass media, the representation of the pink ribbon groups, or the claims of the mammogram industry. The public has been sold a highly biased, distorted picture of the value of mammography (source: “The Mammogram Myth” by Rolf Hefti).

Slowly, the real truth is coming out… but the medical industry, and its allies, continue to fight it with pro-mammogram propaganda.

Kittykitty7555 posted on April 3, 2014 at 10:04 pm

This is truly a tough one. The best evidence shows that screening mammo actually does reduce deaths from breast cancer, yet all-cause mortality remains unaffected. It appears that any mortality benefit from screening is wiped out by the premature treatment-related deaths of women who were overdiagnosed. This has been apparent for at least 10 years, but it seems that very few people are even aware that overdiagnosis (and early death from unnecessary treatment) is within the realm of possibility.

But let’s hope that at least some of the dumb rah-rah happy talk about screening mammography will stop sometime soon. It will be interesting to see how long can the apologists for screening mammo keep the lies coming. At this point they know damn well they are lying.

BabyBoomerWriter posted on April 8, 2014 at 10:16 am

Interesting that medical decisions are now directed to “the public” rather than physicians. It used to be that we relied on our physicians to offer guidance on medical decisions, but as the profession abdicated decision-making to drug, imaging and device firms, schedules of preventive testing and prescribing for everyone became the norm. Rather than select at-risk patients who would benefit from regular preventive measures based on the most current research, many physicians relied on information distributed by medical suppliers and drug manufacturers during sponsored dinners and trips for seminars culminating in less trust of physicians. Today the public relies on published reports they often have difficulty conveying information that is not definitive. It would be be nice to see doctors helping their patients navigate healing after researching their condition and the treatment options.

Patricia Battaglia posted on April 9, 2014 at 10:23 am

Breast cancer is one area where sweeping generalizations and broad recommendations can do a great deal of harm, because the messages are directed toward all women. (Never mind the fact that men get the disease too.) Nuanced balance is always a difficult thing to communicate, but the effort is vital if we are to see any meaningful health reports in the news.