Some bias/some balance in news about ob-gyns’ mammography recommendation

CNN Cohen biased mammo tweet.jpgA physician wrote me this morning, upset about a Tweet from Elizabeth Cohen of CNN, which read:

“To all my sisters over 40: we need mammos once a year. 1 out of 3 don’t get em, so spread the word.”

The physician reacted to a journalist crossing over the line from balanced vetting of evidence into outright blatant advocacy:

• “my sisters”?

• “need”?

Another journalist tweeted: “Mammograms should begin at age 40. Bless you, ACOG.”

The physician wrote to me:

“I can’t understand how a health reporter with a forum like that can write such things. Could a political reporter say Vote for Smith?!”

Bingo. That’s the point I’ve been making for more than year after the oft-biased reporting of the US Preventive Services Task Force’s mammography recommendations in November of 2009.

On many occasions that we’ve written about on this blog in recent years, CNN has demonstrated a bias in favor of screening – touting benefits, minimizing harms. Sanjay Gupta’s badgering of US Preventive Services Task Force member Lucy Marion will always stand out in my mind – and in the minds of many of who saw it – as opinionated “attack” journalism that reflects the polarization we often see in politics now creeping (leaping?) into health care and into health care journalism.

For a different view of how a different network handled the news, see NBC’s Nancy Snyderman on the Today Show, saying “blanket recommendations should be shoved aside…no one-size-fits-all.”

[2017 Update: This video is no longer available]

Meantime, Maureen Salamon, writing for HealthDay, was one of the few who mentioned the quandry of finding ductal carcinoma in situ (DCIS) with earlier mammograms, and also the large number needed to screen in order for just one woman to benefit:

“Some early, noninvasive breast cancers, known as ductal carcinoma in situ (DCIS), never progress to dangerous cases…and mammogram detection may provoke aggressive treatment that ultimately is unnecessary or harmful.

Overall, about 1,900 women aged 39 to 49 would need to be “invited for screening” (though some might decline) to save one woman in that age range from dying of breast cancer, the ACOG said.”

Salamon had just attended the NIH Medicine in the Media workshop at Dartmouth College the previous week and the intensive evidence-based journalism training was undoubtedly fresh in her mind.

Reuters Health included a USPSTF member’s view – balance and perspective lacking in some stories:

“…that small benefit comes with a significant false positive rate, which results in additional testing, including unnecessary biopsies and associated pain and anxiety.”

Half of women screened annually in their 40s will have a false alarm on a mammogram, he said, meaning the test shows something suspicious that turns out to be harmless. Follow-up biopsies can be painful, expensive and carry a small risk of infections or other adverse effects.

With his patients, (the task force member) said, “my bottom line is that I will discuss mammography at age 40, I will recommend and encourage at age 50 and I will strongly encourage at age 60.”

And Deborah Kotz in the Boston Globe included skeptical perspectives that many stories lacked:

“…it is “a leap of faith” to assume that earlier detection via a mammogram can change the course of an aggressive cancer that is going to rapidly spread and kill a woman, said Dr. Lisa Schwartz of the Dartmouth Institute of Health Policy and Clinical Practice. It is not known, she said, how often mammograms detect slow-growing breast cancers that never would have become life-threatening yet still must be treated.

“The idea that it will be better for younger women to have more frequent screening,” said Schwartz, “is . . . not based on scientific evidence.”

And early screening may carry significant downsides, including a 50 percent likelihood that a woman who starts screening at age 40 will test positive when she really has nothing to worry about, warranting follow-up screening or, less commonly, a biopsy.”

I want to end with this reminder/acknowledgement/disclaimer:

• I am not a physician. I do not give health care advice. Nothing I write here should be construed as giving health care advice.

• I’m a veteran health care journalist who addresses bias and imbalance in stories.

• When you review health care news every day as this project does and has done for more than 5 years, you begin to see patterns of institutional or even individual biases shine through in coverage over time. I’m going to keep watching and keep writing about it when I see it because it’s wrong.

Addenda almost 5 hours after original post:

• Merrill Goozner once gave me grief for not disclosing that I once worked for CNN. Yes, in ancient times – 1983-1990 – so long ago as to make it almost irrelevant today. But there it is.

• For more on media bias on mammography stories, see this recent blog post.

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July 21, 2011 at 10:45 am

Great post Gary! Thank you for cutting through the emotionally hyped reporting on mammograms, to give us the”real” scoop. Shared!

Casey Quinlan

July 22, 2011 at 8:33 am

The most important thing a woman can do is know her family health history, and her risk factors, for breast cancer. That said, I was breast cancer’s Patient Zero in my family, so I’m certainly a big fan of the mammogram.
Taking the colonoscopy screening recommendations as a framework, the baseline-at-40 for women who have no family history or high risk factor quotient, along with an every-two-years protocol afterward, might be a better approach than the annual boob-mash. Monthly self-checks don’t hurt, either.
Early detection saves lives. Developing early detection for lung cancer – which now kills more women than breast cancer does – is hugely past due.

Gary Schwitzer

July 22, 2011 at 9:43 am

Thanks for your note.
I’m out of the office traveling and on the run today but wanted to note that some experts on screening issues raise questions about:
• colonoscopy (yes, even about colonoscopy)
• monthly breast self-exams
• current practices of screening for lung cancer
• the notion that “early detection always saves lives.”
I could respond more fully at a later date, or a search of this blog will turn up many past posts on these issues.