NBC’s Nancy Snyderman views drop in mammograms-in-40s as a good thing

We can’t see all news coverage. But we saw enough stories that framed it as only bad news when two new studies this week reported on a decline in mammograms in women in their forties after the US Preventive Services Task Force’s revised recommendations were released in November of 2009. (See our reviews of a Denver Post story that got only two stars and a CNN.com story that got four stars – neither of which looked at the flip side that this could be viewed as a positive development. A CBS News story was headlined, “Are mammography guidelines making breast cancer deadlier?”)

In a Q&A on the NBC Today Show website, NBC News Chief Medical Editor Dr. Nancy Snyderman (who was one of the few in broadcast news to present a balanced view of the USPSTF recommendations 20 months ago), says the decline in mammograms in this group…

“… means patients are listening and making decisions based on their individual health characteristics and risk factors. This is what you want people to do when the science gives them choices.

Ultimately, women and their doctors need to sit down and have this conversation. Early screening can be a great thing, but it comes with its fair share of risks, including radiation exposure and the risk of a false-positive result. The important thing is that for women that decide they want to be screened earlier, they still have the right to choose.”

The online Q&A continued:

“Q. You’ve said that after years of recommending early screening, you changed your views based on the new guidelines. Do you still feel that way?

A. I have always been a supporter of screening and preventive medicine. However, when it comes to the 40- to 49-year-old group, there is no proof that screening saves lives. It may save your breasts, in the sense that earlier detection may give a woman more surgical options in terms of lumpectomy verses radical mastectomy, but it may not add years to your life.

Q. What is the take-home message about breast cancer screening?

A. The take-home message is that women should listen to the controversy and make an informed rational decision about what is best for their health. As uncomfortable as this debate makes people, this sort of inquiry is exactly what makes science great. It’s your body and the more you know about the pros and cons, the more informed your health choices will be. Ultimately, the choice is yours. No one is denying women the right to get a mammogram, but you should know that if you don’t have any risk factors, the science is on your side if you choose to wait until you are 50 to begin annual screening. “

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Elaine Schattner, MD

May 4, 2011 at 11:35 am

I can’t help but wonder – would Dr. Snyderman’s comments have been featured on this site if she had, instead, expressed concern about the drop in mammography? Where’s the balance here?

Gary Schwitzer

May 4, 2011 at 12:00 pm

Well, let’s talk about balance.
We reviewed or commented on three mainstream news media stories that – as we stated – never hinted at the possibility that a decline in mammography could be a good thing. That it could be a sign of shared decision-making taking place.
Snyderman’s online Q&A did that, so by posting it, indeed, some balance was introduced into the public discussion.
More balance?
Today I linked to a post by Dr. Len Lichtenfeld of the American Cancer Society, whose organization has a markedly different view on mammography in this age group than does the USPSTF.
And I posted your comment.
Let me reiterate what you apparently miss in my intent: I’m not a health care professional. I don’t give health care advice. I’m been covering health care issues for 38 years. I do give journalism and communication advice – which, on this issue is: There are tradeoffs involved in screening decisions. Stories or messages that don’t convey that are incomplete and potentially harmful. I wouldn’t tell anyone to be screened or not to be screened. But I will promote improved health care journalism that communicates the tradeoffs – the benefits AND the harms – that can occur. Period.

david holmes

May 16, 2011 at 9:20 pm

I was diagnosed with prostate cancer in 2004, and joined the thousands of men who receive obsolete, damaging examinations and treatment with drugs. Ignorant of the options and damaging effects of drugs, I allowed myself to be given Flutamide. At the end of 3 1/2 years on the drug, I was overweight, impotent, depressed, and recovering from a bypass operation. Almost 5 years passed taking the drug, when I discovered the the Am. Heart Assoc. had red-flagged the drug because of the serious damage caused to the cardio-vascular system, which could be seen within 6 months of starting the regimen. I also discovered that 3 years was considered an optimum period on the drug. I stopped taking it, and challenged my urologist who proceeded to lie his way out of the situation. Breast cancer still gets more exposure than prostate cancer, but men are misdiagnosed, mistreated, and actually suffer greater damage to their system than they would have without the drugs. I am seriously considering suing the urologist. Research has been contradicting the means of testing for prostate cancer, and the means of combatting it. I would like to see some reports in the media about the irresponsibility of the cancer treatment industry, using out-dated methods, soaking up hundreds of million of dollars with no noticeable results, and doing it all merely for the purpose of making money. I also have three daughters whom I have warned, and supplied with up-to-date information on thermograms as opposed to traditional mammograms (if testicular cancer was tested in the same way as breast cancer the method would have changed decades ago). Cancer patients need to be better informed about treatment choices and not simply exposed to the three favourites – Mutilation, Medication, and Radiation.