HealthNewsReview.org | Independent Expert Reviews of News Stories | Holding Health and Medical Journalism Accountable |
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Breast cancer and MRIs
August 04, 2008
This story, a response to actress Christina Applegate’s diagnosis with breast cancer, was thin on evidence. And it gave viewers recommendations on screening that are not supported by the evidence.
Our Review Summary
The story reviews various methods of screening for breast cancer and notes follow-up procedures (i.e. biopsies and other surgeries) if cancer is found via MRI after mammography. The story mentions some of the downsides of screening average-risk women with MRI in addition to mammography. The story, via discussion of actress Christina Applegate's familial history of breast cancer, provides a general picture of who might be at higher-risk and a candidate for more sensitive screening. The story does not mention that MRI screening is not always covered by insurance for women at low to average risk of developing breast cancer. MRIs can cost $1000-1500 so these are about ten times as expensive as mammograms.
The story fails to mention the lack of good evidence for other screening recommendations. For example, the story notes that self breast exams "should begin at 20". There is little evidence that breast self-examinatin (BSE) lowers deaths from breast cancer, and SBEs are not recommended by themselves for detecting breast cancer, especially in higher-risk women. Based on current evidence, USPSTF does not recommend for or against BSE (USPSTF 2002).
While the American Cancer Society recommends annual mammograms starting at age 40, this is an area of controversy and one where women need to determine their individual risk and benefits of screening: http://www.annals.org/cgi/reprint/146/7/I-20.pdf
While the story discusses the cons of MRI screening, it does not mention that these same downsides (namely, increased risk of false positives, unnessessary treatment and anxiety) are the same for younger, lower to average risk women who have mammography alone.
Click on Criteria for definitions.
The story reviews various methods of screening for breast cancer and notes follow-up procedures (i.e. biopsies and other surgeries) if cancer is found via MRI after mammography. The story does not mention that MRI screening should be performed at centers that also do breast biopsies. These centers may not be available to all women.
The story does not list the cost of this adjunct screening tool to mammography. MRIs can cost $1000-1500 so these are about ten times as expensive as mammograms. The story does not mention that MRI screening is not always covered by insurance for women at low to average risk of developing breast cancer.
The story engages in disease-mongering in its conclusion: "What's most important is to screen. One in eight women nowadays is going to get a breast cancer in her life, so as long as you get in for screening, I'm happy." The 1 in 8 statistic requires explanation. It is a lifetime incidence estimate. Many women misinterpret this to think that they have 1 in 8 chance right now at this time in their life. It is one of the misused and most misunderstood statistics in health care. The National Cancer Institute estimates that a typical 40-year old woman has less than a 2% (1 in 50) chance of developing breast cancer before 50, and less than a 4% (1 in 25) chance of developing it before age 60.
But the story also states, "But generally, we start home breast exam at age 20. I suggest every month, at the same time of the month, examine your breasts at home and get into your doctor for a breast exam at least every three years, earlier if you can." This is not an evidence-based recommendation and involves a physician-reporter giving personal advice and perhaps forgetting that she is now a reporter.
The story notes that self breast exams "should begin at 20". There is little evidence that breast self-examination (BSE) lowers deaths from breast cancer, and SBEs are not recommended by themselves for detecting breast cancer, especially in higher-risk women. Based on current evidence, USPSTF does not recommend for or against BSE (USPSTF 2002).
Experts disagree that mammography screening "should begin at 40", especially for women at low to average risk. http://www.annals.org/cgi/reprint/146/7/I-20.pdf
The story discusses the cons of additional MRI screening, but does not mention that these same downsides (namely, increased risk of false positives, unnessessary treatment and anxiety) are the same for younger, lower to average risk women who have mammography alone.
The story does mention some of the downsides of screening average-risk women with MRI in addition to mammography. The story, via discussion of actress Christina Applegate's familial history of breast cancer, provides a general picture of who might be at higher-risk and a candidate for more sensitive screening. However, one relative would not necessarily place a women in a higher-risk category.
The story discusses the recent use of MRI in the context of listing other tools typically used for breast cancer detection.
The story does not quantify the benefit of additional MRI screening for women who are considered high-risk. It doesn't give viewers any sense of how much more MRIs may help. Overall, the story is thin on presenting any evidence.
The story does not appear to be driven by any news release, but by an actress and breast cancer advocate's diagnosis of breast cancer via MRI and mammography.
Information in the story is conveyed via the network medical reporter. Clinicians and/or radiologists who use MRI and mammograms in the clinical setting should have been interviewed.
The story mentions that Christina Applegate will receive treatment for breast cancer, but treatments are not discussed. However, the story focuses on screening methods, namely MRI for higher-risk women. Various screening methods are discussed.
Total Score: 4 of 10 Satisfactory
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