Faithful to the latest journal article, many news organizations dutifully reported what they were told by authors of a study published in the Journal of the American Medical Association, “Breast Cancer Screening Using Tomosynthesis in Combination with Digital Mammography.” The list of stories that resorted to sensational language – breakthrough, game-changer, best way of detection, any woman should have this, lifesaver – was long.
But a few news organizations – and reporters – stood out for asking tougher questions.
Liz Szabo and USA Today reported, “3-D mammograms find more cancers, but do they save lives?” In the second sentence, she wrote, “Other breast cancer advocates caution that doctors still don’t know whether finding these extra cancers will actually save lives, however, or simply lead more women to treatment.” Later, this:
“The absolute differences between (3-D and standard mammograms), in terms of the number of cancers found, is very small, says Fran Visco, president of the National Breast Cancer Coalition. And other benefits are uncertain.
The study didn’t follow women over time. So doctors don’t know whether undergoing tomosynthesis actually saves lives, Visco says.
Many cancer researchers estimate that 1% to 10% of breast cancers are “overdiagnosed,” or treated even though they would never have become life-threatening. A screening that finds more breast cancers only helps women if the test also reduces their risk of dying, Visco says.
Without following women for many years, doctors also can’t tell whether tomosynthesis missed a lot of cancers, according to an accompanying editorial by Etta Pisano of the Medical University of South Carolina and Martin Yaffe of the University of Toronto. In their editorial, they urge the National Cancer Institute to fund a trial to answer these questions.
Even if that trial is conducted, its results would come long after tomosynthesis has hit the market, says the American Cancer Society’s Robert Smith. Many breast centers have been heavily marketing the screenings for years.”
Denise Grady in the New York Times wrote in her third paragraph:
The verdict is still out on the long-term worth of this new technology. The new results are promising but not definitive, according to experts not associated with the study, published Tuesday in The Journal of the American Medical Association. Tomosynthesis has not been around long enough to determine whether it saves lives or misses tumors.
Even so, more and more mammography centers are buying the equipment, which is far more costly than a standard mammography unit, and marketing the test to patients as a more sensitive and accurate type of screening. It has come on the scene at a time when the value of breast cancer screening and the rising costs of health care are increasingly debated.
Debora Kotz of the Boston Globe included these observations:
Screening experts, however, caution that lifesaving benefits were not seen in the new study. “Finding more cancers isn’t our goal,” said Dr. Lisa Schwartz, professor of medicine at the Dartmouth Institute for Health Policy and Clinical Practice. “It’s about reducing breast cancer deaths. We don’t know whether this new technology finds more cancers destined to kill people.”
“There’s a debate about the harms of screening and overdiagnosis of breast cancers from mammograms and to me, this doesn’t resolve that,” said Dr. Etta Pisano, a breast imaging radiologist at the Medical University of South Carolina who wrote an editorial that accompanied the study.
Some women may benefit more from tomosynthesis than others, such as those with dense breasts that tend to obscure tumors — which are also dense — in traditional 2-D mammograms. “Maybe women who don’t have dense breasts do just as well with digital mammograms,” Pisano added. “I don’t think every woman should be seeking out (tomosynthesis or 3D mammograms) at this point.”
Charles Bankhead of MedPage Today ended with a quote from Harold Burstein, MD, PhD, of Dana-Farber Cancer Institute in Boston.
“If we step back and ask whether these papers show that better breast imaging will actually translate into lives saved, it’s unclear. This [JAMA article] is a paper where the differences are small enough that you want to analyze very carefully the trade-offs in terms of extra biopsies, extra imaging effort, and the extra cost involved, before thinking that it should be a routine piece of our public health screening for breast cancer,” he added.
Countering the “game-changer” prediction made by some, a Wall Street Journal story ended with this:
Radiologists not involved in the JAMA study were more reserved.
“Tomosynthesis is an important improvement, but is this a game-changer? I don’t think so. There are still many unanswered questions,” said Carol Lee, a radiologist at Memorial Sloan Kettering Cancer Center in New York, which offers 3-D mammograms as a free option.
This list is incomplete. But it gives you an idea of what a difference independent perspectives, asking tough questions, and independently vetting claims – not just practicing journal stenography – can make for ensuring accuracy, balance and completeness in health care news.
I was interviewed about this topic on the Healthstyles program of the Center for Health Media & Policy at Hunter College on WBAI radio in New York City.
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