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Informative report on mammogram recommendations could have quantified lives saved

New breast cancer screening guidelines at odds with Congress

Our Review Summary

Nurse Assisting Patient Undergoing MammogramThe story provides a good overview of new recommendations from the U.S. Preventive Services Task Force (USPSTF) on when, and how often, women should receive mammograms to screen for breast cancer. The story summarizes the long-running debate over mammogram recommendations, particularly congressional action on the issue. The story also discusses the differing advice that various organizations provide on when women at average risk of breast cancer should begin mammogram screening, though the story would have been stronger if it had more fully explored both the benefits and potential harms associated with women starting mammogram screening early or having the tests more often (something that a competing New York Times story on the recommendations does well). The story also offers a good discussion of issues related to what the USPSTF recommendations may mean for insurance coverage of mammograms, though it does not tell readers how expensive mammograms may be without insurance.

 

Why This Matters

Breast cancer screening is a big deal. As the CDC notes, “Not counting some kinds of skin cancer, breast cancer in the United States is the most common cancer in women, no matter your race or ethnicity.” In 2012 alone, 41,150 women died of the disease. Breast cancer also has a profound impact on the economy, with researchers estimating that it costs the U.S. billions of dollars each year. In other words, it affects the health and well-being of millions of patients and their loved ones, as well as having an adverse impact on the economy. News that relates to the early detection and treatment of breast cancer is clearly news worth covering, particularly when it could inform the decision-making of women and health professionals — and have an effect on women’s access to screening.

Criteria

Does the story adequately discuss the costs of the intervention?

Not Satisfactory

The story does address how the USPSTF recommendations may affect insurance coverage of mammography screening, as well as related congressional action mandating that insurers cover such screening. However, the story does not tell readers the bottom line: how much would a mammogram cost if it were not covered by insurance? While we found varying estimates, a 2011 paper stated that the overall cost of a mammogram was $266 — a considerable sum, and likely out of reach for many women. This was a shortcoming of both the Washington Post and New York Times stories.

Does the story adequately quantify the benefits of the treatment/test/product/procedure?

Not Satisfactory

The story does not offer any detailed information on the potential benefits associated with mammogram screening. Instead, the story uses vague language, describing the USPSTF’s recommendations as saying that “screening mammography had the greatest benefit for women ages 50 to 74” and that “the likelihood of benefit is less” for women in their 40s. Exactly how much different are the potential benefits for these groups? That’s an important point, and the story doesn’t tell us.

The story does note that the USPSTF recommendations are aimed only at women with an average risk of breast cancer, and it attempts to explain what that means, noting that it refers to women “who don’t have specific risk factors for breast cancer such as the BRCA1 and BRCA2 genetic mutations or a family history of the disease.” That’s useful information for readers, but the story could have noted that there are other factors that place women at elevated risk. A history of prior breast surgery, especially if the pathology demonstrated atypical hyperplasia [an abnormal overgrowth of cells] significantly increases the risk of a subsequent breast cancer. In addition, a woman’s menstrual history, age at first pregnancy, and other factors also influence risk. There are several risk assessment models that are widely available, but are underutilized, to help women and their physicians assess risk. It would have been helpful to at least acknowledge this, as there remains a lot of confusion over just what constitutes “average risk.”

Does the story adequately explain/quantify the harms of the intervention?

Satisfactory

The story addresses harms briefly in two places. In one place, the story refers to “the anxiety and potential harm caused by over-diagnosis and false positives,” though it doesn’t explain what over-diagnosis or false positives mean (potentially leaving many readers in the dark). The story also notes that “The most serious potential harm is unneeded treatment for a type of cancer that would not have become a threat to a woman’s health during her lifetime.” But it doesn’t give readers any idea of how serious this harm might be, or how common this scenario is. In short, the story does enough to earn a Satisfactory rating, but could have (and should have) done more. It’s worth noting that the New York Times piece did a top-notch job discussing harms.

The story does, however, make clear that women should be informed consumers, and that — if well-informed — women should have the authority to weigh potential benefits against potential harms and make their own decisions about when and how often to get screened. That’s an important point, and one worth making.

Does the story seem to grasp the quality of the evidence?

Not Satisfactory

There is no specific study to evaluate or discuss in a story like this one; the USPSTF’s recommendations are based on an evaluation of all the available research literature on breast cancer screening and mammography. However, the story could have simply said that. As it is, while the story does tell readers what the USPSTF is, it doesn’t say anything about what the task force based its recommendations on.

Does the story commit disease-mongering?

Satisfactory

No disease mongering here.

Does the story use independent sources and identify conflicts of interest?

Satisfactory

The story incorporates input from several independent sources. Comments from Fran Visco of the National Breast Cancer Coalition are worth repeating: “Women are capable of understanding the complexities of the issue, evaluating the evidence and making their own health decisions.”

Does the story compare the new approach with existing alternatives?

Satisfactory

The alternatives in a story like this one are the recommendations from other organizations. And the story does explain varying recommendations from the USPSTF and two other groups: the American College of Obstetricians and Gynecologists, and the American Cancer Society.

Does the story establish the availability of the treatment/test/product/procedure?

Satisfactory

The story makes clear that the use of mammograms as breast cancer screening tools is longstanding and well established. The story also discusses insurance coverage issues that would affect availability for many women.

Does the story establish the true novelty of the approach?

Satisfactory

The story does tell readers that the new recommendations on mammograms and breast cancer screening are consistent with the USPSTF’s 2009 recommendations — which triggered a fierce (and still ongoing) debate over the issue. The story also offers a good primer on congressional action related to the debate, particularly as pertains to legislation that mandates insurance coverage of mammograms for breast cancer screening.

Does the story appear to rely solely or largely on a news release?

Satisfactory

The story clearly includes original reporting and goes beyond what would be found in a news release.

Total Score: 7 of 10 Satisfactory

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