The following is a guest blog post from Kathlyn Stone, who is an Associate Editor for HealthNewsReview.org. That means she’s the one who wakes up every morning and finds the news stories that are eligible for review by our team of reviewers.
We recently saw many headlines claiming that the incidence of breast cancer in the United States would rise 50 percent over the next 15 years. The major stories all hit within 24 hours after National Cancer Institute researchers released their study at the American Association of Cancer Research annual meeting.
The 600-some word news release, headlined “U.S. Breast Cancer Cases Expected to Increase by as Much as 50 Percent by 2030,” explained that the projection was based on national surveillance data, census bureau data and mathematical models. The aim of the project was “to help the oncology community develop a proactive roadmap to optimize prevention and treatment strategies,” according to the researchers.
However, the projections are based on the continuance of intense screening through mammography, which, the researchers noted, has “been well-accepted in the United States.” They also may rely a bit on the cherry-picking of breast cancer types included.
NCI researchers included ductal carcinoma in situ (DCIS) in their projections. DCIS is an increasingly common abnormal finding that will result from a mammogram. “Adding DCIS into the projections when it is not an invasive cancer is a way to plump up the numbers and give a skewed impression,” Gayle Sulik, PhD, a medical sociologist at the University at Albany, NY, and executive director of the Breast Cancer Consortium, wrote in an e-mail in reference to the breast cancer incidence report.
“Yes, it’s definitely disease mongering,” says Sulik. “At the point when advisory boards, clinicians, and patients are actively and conscientiously reconsidering screening recommendations, there is a push back. This kind of headlining puts fear and risk back on top as the primary motivators for people to accept unnecessary and potentially harmful medical interventions, including screens.”
In the report, DCIS represents about 50 percent of the projected new cancers by 2030. However, there’s growing consensus in the medical community that DCIS should be reclassified into a non-cancer category because it’s rarely life-threatening, even when left untreated.
In fact, some experts feel uncomfortable even describing DCIS as breast cancer. At a 2009 consensus conference hosted by the NIH, experts called for removal of the word “carcinoma” from DCIS, and a renaming of the diagnosis.
As the NCI states on its web page about DCIS treatment, “Some people include DCIS in breast cancer statistics.” The implication is, of course, that others do not.
The bottom line is, the 50 percent increase headline wouldn’t be possible without the inclusion of DCIS in the survey.
The NCI surveillance report is “moderately complicated so a brief news story that hits the high spots runs the risk of scaring people without educating them,” says Russ Harris, MD, MPH, a professor of medicine at UNC-Chapel Hill. “There’s a chance people won’t look past the headline and fear will escalate.
“If you’re writing a news article you have to go beneath the surface. I would want reporters to dig down deeper. There’s good and bad news” surrounding the data, he says.
While ER-positive, the most common (and treatable) type of breast cancer is rising, “The good news is that the bad kinds of breast cancer [ER–negative] that kill more people seem to be going down a bit,” Harris says.
So how did health writers cover the report?
Several did dig deeper, but they required readers to dig deeper, too. If one read past the fifth paragraph in this Washington Post article they’d find that there is some controversy “over the role of mammography and the definition of some kinds of breast cancer.” The Post story continued:
Last July, a panel of the National Cancer Institute concluded that improved screening has resulted in the over-diagnosis and over-treatment of cancers that are not life-threatening, without significantly reducing the death rate from the disease.
Some experts also believe the time has come to stop considering “ductile [sic] carcinoma in situ”–the presence of abnormal cells in the milk ducts of the breast–as a cancer, because the disease is not invasive and does not threaten women’s lives if left untreated. Yet because of the term “cancer,” women sometimes choose mastectomies when they receive the diagnosis.
“Right now, we have women getting bilateral mastectomies for ductal carcinoma in situ, which is not a cancer,” Otis Brawley, chief medical officer of the American Cancer Society, said at the time. “It’s the world turned upside down.”
TIME sought an outside opinion from a source who voiced concern about in situ diagnosis.
“We don’t want to end up diagnosing and treating a disease that would never cause a problem during the person’s natural lifetime.” said the source, Dr. Sharon Giordano.
Not all in-situ breast cancer progresses into a dangerous condition, Giordano explains. “One of the unanswered questions is, how do we identify the in-situ cancers that are the ones that go on and progress to a life-threatening illness, and which are the ones that we should be leaving alone and not subjecting people to invasive surgery and radiation for treatment?”
If only there was a way to acknowledge that the 50 percent increase is dependent on how breast cancers are defined, if not in the headline, then in the lead paragraph. A more accurate, less snappy headline like “Breast Cancer Cases Could Increase 50 Percent by 2030 (If You Include Non-invasive Stage 0 Diagnosis),” isn’t likely to get published.
Yahoo Health provided a caveat to the report’s main message with its headline: “U.S. Breast Cancer Rates Will Increase 50% By 2030 (But It’s Not All Bad News).” Unfortunately, the story didn’t delve into the controversy over DCIS.
With DCIS being found more often, and having this much of an impact on statistical projections, journalists need to help the general public understand this condition – what it is, what it isn’t, and what’s unknown about it.