American Cancer Society chief medical officer Dr. Otis Brawley has gone on the web with two recent videos on screening issues. His latest is on the continuing discussion about mammography recommendations for women in their 40s. The video appeared on the CNN website.
Dr. Brawley is an effective communicator. His mammography message in this clip is moderate and acknowledges that the number of lives saved by mammography in the 40s “is quite small.” But there was one glaring omission in his message: he never mentioned harms. This is a recurring theme in the discussion of screenings’ benefits and harms: the benefits tend to be emphasized and the harms tend to be minimized – or, in this case, ignored altogether.
Talk to women who’ve had false positive mammogram results and you’ll hear stories of harm. Talk to women who’ve received a diagnosis of a sometimes so-called “non-invasive” cancer like DCIS or ductal carcinoma in situ and you’ll often hear stories of harm. And such findings may occur more often the younger you do mammograms.
For truly shared decision-making to take place, women need to be given accurate, balanced and complete information on not only benefits but on harms. Then they can make their own decision. That is precisely what the US Preventive Services Task Force wrote – a recommendation that was misconstrued and miscommunicated by many who knew better. USPSTF authors wrote:
“The decision to start regular, biennial screening mammography before the age of 50 years should be an individual one and take patient context into account, including the patient’s values regarding specific benefits and harms.”
One of our medical editors once urged me to educate journalists about this true statement:
“ALL SCREENING TESTS CAUSE HARM; SOME MAY DO GOOD AS WELL.”
That’s a message that was missing in this video, as it usually is in screening discussions. We can do better.
One example of “the other side” to this discussion was published in the Washington Post this week – “Nurse practitioner explains why she refuses to endorse routine mammography.” ( Excerpted from the October issue of Health Affairs.)