Imbalanced, inaccurate reporting on USPSTF breast screening recommendations

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For example, an AP story that had 6 voices of people criticizing the new recommendations and only 4 who supported them.

Within that story there was more troubling imbalance and even inaccuracy. It allowed one woman to say “I don’t know how the US government or a panel of government officials can think they know better than the American Cancer Society.”

That statement went unchallenged.

The US Preventive Services Task Force is NOT “the US government or a panel of government officials.” The task force is made up of independent primary care doctors and others whose stated interests include: decision modeling and evaluation; effectiveness in clinical preventive medicine; clinical epidemiology; the prevention of high-risk behaviors in adolescents; geriatrics; and the prevention of disability in the elderly.

The AP story also included the perspective of one Chicago-based breast cancer advocacy group that opposed the recommendations, but didn’t include the perspectives of two much larger national advocacy groups that support the recommendations – the National Breast Cancer Coalition and Breast Cancer Action.

One of my local TV stations – KMSP Fox 9 in Minneapolis – had a story with a single patient anecdote: a woman who said her life was saved by a mammogram in her 40s.

Why weren’t there any anecdotes like the one I wrote about recently – from the Sunday Times of the UK – a story about harms and regrets from breast cancer screening.

And I already wrote last night about CBS’ physician-“correspondent” Dr. Jennifer Ashton concluding her story about the USPSTF recommendations by telling viewers she’d have a hard time accepting them and sharing them with patients.

This is not journalism. This is not how journalists can lead a discussion about evidence-based medicine. Rather, this is how journalism gets swept away by the one-sided rhetoric of rationing.

Already – once again – I see online commenters referring to the independent panel’s recommendations as signs of what’s to come with “Obamacare.” If we can’t elevate the discussion about evidence-based medicine any higher than that, we are doomed.

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Comments

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Megan McAndrew

November 17, 2009 at 9:38 am

Interesting that no one appears to have thought this through far enough to wonder about the catastrophic economic impact on breast imaging centers, radiologists, Picker – and all that billboard advertising. Breast Cancer Inc. is at risk here.

Evan Falchuk

November 17, 2009 at 9:41 am

Gary,
You raise a great point about the reality of these recommendations, and the journalistic failure.
But public reaction to this kind of thing is predictable, and not caused by bad journalism.
When you do anything that is seen as interfering with health care decisions or health care benefits, you create a great deal of anxiety and resistance. Private and public employers can tell you all about this sort of thing because they deal with it all the time.
So, while you are correct that this study isn’t part of reform, good luck convincing anyone who isn’t a policy wonk of this.
The extent to which the reform effort is an just like an employee benefits roll-out gone horribly awry is the real story behind the public reaction to this otherwise valuable study.
Related thoughts here: http://bit.ly/1XVuNv
Cheers,
Evan Falchuk

Paul Scott

November 17, 2009 at 1:20 pm

The public reaction against recommendations like this is driven by the anti-science bias of stories like the AP story described here. I think the fallout from these recommendations is going to tell us a lot about how difficult it will be to disrupt the sense of entitlement — I want my insurer to pay for treatments because they give me comfort — that is costing our health care system so very much.

Eduardo Alvarado, MD

November 18, 2009 at 12:50 am

I think this decission is made based on evidence and not just on economics. My sister was diagnosed with breast cancer at age of 35, with no risk factors for the disease. Her lesion was evident on a mamography, even if it is not the test of choice for patients at her age. Would I recommend mammography screening for everyone around 35 based on this PERSONAL experience? Absolutely not. I did not even did it for her. We cannot just recommend CT based for everyone just because a pancreatic tumor was found on grandma’s CT scan (performed for any other reason). That is not the way money should be spent on health care. It can be “spent” (I prefer the word “invested”) in many other ways, without losing its “human” sense.

Elizabeth L.

November 18, 2009 at 6:28 am

I’m amazed the USPSTF had the guts to call it like it is. It’s about time the mounting evidence of harms was recognized and reflected in guidelines. There will be a firestorm of controversy, I’m sure, and I hope they are prepared to weather it.
One problem is that only a portin of the early lesions detected by mammmography (ductal carcinoma in situ) are ever going to cause a woman problems in her lifetime — yet once they are recognized and a woman undergoes treatment, her perception is that she has been “saved”, not harmed, by mammography. It’s difficult to counter those emotional testimonials, but it’s almost certainly the case that many of the most vocal supporters of mammography have in fact been harmed by it rather than helped.
I do not think medical history will judge our current approach to breast and prostate cancer screening kindly, once the dust settles.