Not much prostate cancer awareness in ABC’s Bobby Bowden revelation

In a highly-promoted appearance, legendary Florida State football coach Bobby Bowden went on ABC’s Good Morning America yesterday to announce that he had kept silent since 2007 about his diagnosis with prostate cancer.

First, let me say that I’ve always liked this guy. Funny. Charming. Coached teams that were fun to watch.

But that doesn’t make you an effective communicator on prostate cancer.

If you listen very carefully to the following clip (it took me 3 times watching the clip before I caught this), you’ll hear interviewer Robin Roberts rapidly mention that Bowden “is being compensated” for his appearance by “On the Line.”

On the Line” is sponsored by several entities including two drug companies that make prostate cancer drugs and by Project Zero – whose executive made news on this blog recently by writing that Dr. Otis Brawley of the American Cancer Society “has killed more men by giving them an excuse to not be tested.”

You could probably find less conflicted sources than a man who’s being reimbursed by an outfit funded by those sponsorships.

Here’s an excerpt from Coach Bowden telling his story on ABC:

“So anyway, he was telling me I had cancer in my prostate, and this is what we need to do and what do we want to do? And they decided what to do and did it the next day and then six months later they checked up and everything was gone, so I’m a survivor.”

Nothing about what the treatment was like.

Nothing about shared decision-making. (Doesn’t sound like much shared decision-making took place: “…and they decided what to do…”)

Just snap, crackle, pop: diagnosed one day, treated the next day, apparently a piece of cake. Nothing about side effects of treatment – a great source of concern to most men.

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He kept referring to “one out of 6 men are going to get it.”

Coach Bowden: “Now if I told you you’re going to fly to California tomorrow. I’m going to fly you out there, but there’s one out of six chances that plane is going to crash…”

Robin Roberts: “HE’S TELLING YOU. GO GET CHECKED OUT…”

Bowden: “…you wouldn’t go. Haha. You wouldn’t go. Haha.”

Now think for a moment about what we know about prostate cancer:

• The American Cancer Society reminds us:

“Some prostate cancers can grow and spread quickly, but most of the time, prostate cancer grows slowly. Autopsy studies show that many older men (and even younger men) who died of other diseases also had prostate cancer that never caused a problem during their lives. These studies showed that as many as 7 to 9 out of 10 men had prostate cancer by age 80. But neither they nor their doctors even knew they had it.”

• So prostate cancers are often harmless- and some – especially in men the coach’s age are often regarded as appropriate for “watchful waiting” rather than aggressive treatment. Then think about whether a 1 in 6 chance of being in a plane crash is really comparable to a 1 in 6 chance of being diagnosed with prostate cancer.

That 1 in 6 – like the oft misunderstood 1 in 8 for breast cancer in women – is a lifetime risk. The National Cancer Institute reminds men:

“Sometimes it is more useful to look at the probability of developing cancer of the prostate between two age groups. For example, 8.30% of men will develop cancer of the prostate between their 50th and 70th birthdays.”

So instead of the 1 in 6 number, in the age range of 50 – 70, the risk is 8 in 100. Sounds a little different, doesn’t it?

Anchor Robin Roberts could have helped matters by asking information-seeking questions rather than throwing up fan-like softballs. For fans, it was good to hear from the Coach again. For men trying to learn about prostate cancer during prostate cancer awareness month, it was a good time to go to the bathroom.

Any Florida State football fan knows what “wide right” means – recalling painful memories of famed missed kicks in bitter rivalry games against the University of Miami.

Unfortunately Coach Bowden – and especially ABC – were “wide right” this time as well.

Recap:

• I’m very happy to see that the Coach appears to be doing great.

• This is about journalism – and about the use or misuse of a national television platform.

• This was about opportunity missed. ABC editorial decision-makers will undoubtedly say to themselves, “Nice job. We covered prostate cancer awareness.” No, you didn’t.

• Just read the source material I cited from the American Cancer Society and the National Cancer Institute to see how much more useful information you could have disseminated.

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Comments

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Miranda

September 14, 2011 at 9:37 am

I’ve learned so much from your blog…I thought of all of this instantly when I saw Bowden speak about this on ESPN yesterday.

Joshua Schneck

September 14, 2011 at 2:19 pm

Thank you for great commentary once again on prostate cancer coverage. I would like to point out that “active surveillance” is the preferred way to describe the option of forgoing definitive treatment (like surgery or radiation) and carefully monitoring the patient for signs of cancer progression. The old “watchful waiting” usually amounted to ruling out “definitive treatment at the outset and providing symptomatic treatment if disease progressed locally or at distant metatastic sites.” (Source: UpToDate) Modern active surveillance defers treatment until signs of progression occur, at which point the option of definitive treatment is offered the patient. The distinction is important because the media sometimes carries stories about the Swedish studies supposedly “proving” that surgery offers better results than not treating. But the Swedish studies usually cited refer to old watchful waiting and not modern active surveillance of men with asymptomatic prostate cancer detected by PSA testing and biopsies.

Gary Schwitzer

September 14, 2011 at 2:31 pm

Josh,
I know. And you’re correct about “active surveillance” being a new preferred term by experts to describe the option of forgoing definitive treatment rather than the older “watchful waiting.” I thought about it before I published this.
But I also wonder if there’s ever been any good research done about how patients facing decisions understand these terms.
In the end, it’s probably the discussion – not the label – that matters most.

Joshua Schneck

September 14, 2011 at 2:55 pm

I completely agree with you. But I wonder how much truly balanced information most prostate cancer patients are actually given in the first place. I had to dig long and hard myself to get comprehensive information on this subject when I was diagnosed. It certainly did not come from my doctors.
What some research points at is that the biggest determiner of treatment choice is the specialty of the physician working with the patient. See
Predictors of Patient Preferences and Treatment Choices for
Localized Prostate Cancer – http://www.hks.harvard.edu/fs/rzeckhau/Cancer_Predictors_Prostate.pdf – prepared for publication in Cancer. Sadly, they found that the physician specialty was a bigger factor than patient preference. In other words, the surgeon recommended surgery, the radiation guy recommended radiation…

Robert Brooks

September 15, 2011 at 6:19 pm

Here’s the problem with what appears your attacks on prostate cancer testing: No one knows the severity of prostate cancer from one patient to the next. That’s why you test and follow up and collect all the information you can and make an informed decision. There isn’t a test that can tell how quickly your tumor might grow. Until there is – we’re stuck with the PSA test. As a “journalist” you should chose your words better. Pointing out the flaws only is fair and balanced, saying it’s important to get tested and know the facts about your individual circumstance is fair and balanced. It’s too bad you chose the former.

Robert Brooks

September 15, 2011 at 6:28 pm

Here’s the problem with what appears your attacks on prostate cancer testing: No one knows the severity of prostate cancer from one patient to the next. That’s why you test and follow up and collect all the information you can and make an informed decision. There isn’t a test that can tell how quickly your tumor might grow. Until there is – we’re stuck with the PSA test. As a “journalist” you should chose your words better. Pointing out the flaws only is fair and balanced, saying it’s important to get tested and know the facts about your individual circumstance is fair and balanced. There are no harms in having the test, there is only harm in being under informed about treatment options. You lump the two together and it’s dangerous and careless. It’s too bad.

Gary Schwitzer

September 15, 2011 at 6:29 pm

Robert,
Thanks for your note.
But you make several misstatements and unsupported allegations.
I don’t “attack” prostate cancer testing.
I address imbalanced, incomplete messages.
Evidence-based medical and scientific bodies do not agree with you that it is “fair and balanced” to say to ALL men that “it’s important to get tested.”
The US Preventive Services Task Force does not say that. The American College of Physicians does not say that. The American College of Preventive Medicine does not say that. The American Academy of Family Physicians does not say that.
In a separate note, you wrote “There are no harms in having the test, there is only harm in being under informed about treatment options.”
Again, I’m afraid that evidence-based organizations disagree with you:
• “What we are trying to say to men is the harms (of prostate screening) are better proven than the benefits,” said Dr. Otis Brawley, chief medical officer of the American Cancer Society. While these tests can detect cancer, they also can produce false positive results that lead to unnecessary and uncomfortable biopsies and treatments that carry undesirable side effects such as impotence and urinary incontinence.
• The US Preventive Services Task Force found convincing evidence that treatment for prostate cancer detected by screening causes moderate-to-substantial harms, such as erectile dysfunction, urinary incontinence, bowel dysfunction, and death. These harms are especially important because some men with prostate cancer who are treated would never have developed symptoms related to cancer during their lifetime. There is also adequate evidence that the screening process produces at least small harms, including pain and discomfort associated with prostate biopsy and psychological effects of false-positive test results.
In the end, Robert, you should choose your words – and your facts – more carefully.

Robert Brooks

September 16, 2011 at 10:12 am

I’m talking about testing, you’re talking about treatment. They are not one in the same. Finally, the USPSTF committee does not have a single urologist or oncologist on the panel. I’d rather take my advise from a doctor.

Gary Schwitzer

September 16, 2011 at 10:31 am

Robert,
Again, I must disagree while pointing out that you have again misstated what I wrote.
I AM talking about testing. I wrote:
Evidence-based medical and scientific bodies do not agree with you that it is “fair and balanced” to say to ALL men that “it’s important to get tested.”
The US Preventive Services Task Force does not say that. The American College of Physicians does not say that. The American College of Preventive Medicine does not say that. The American Academy of Family Physicians does not say that.

And I specifically wrote about potential harms of screening when I quoted Dr. Otis Brawley of the American Cancer Society saying, “What we are trying to say to men is the harms (of prostate screening) are better proven than the benefits.”
And the USPSTF addresses both direct harms of screening (including pain and discomfort associated with prostate biopsy and psychological effects of false-positive test results) and ensuing harms (treatment for prostate cancer detected by screening causes moderate-to-substantial harms, such as erectile dysfunction, urinary incontinence, bowel dysfunction, and death. These harms are especially important because some men with prostate cancer who are treated would never have developed symptoms related to cancer during their lifetime.)
You are also wrong when you imply that there isn’t a doctor on the USPSTF when you say “I’d rather take my advise from a doctor.” 13 of the 16 current USPSTF members are MDs – http://www.uspreventiveservicestaskforce.org/members.htm – and the other three are PhDs, two of whom are also RNs.
It is also a fallacy to suggest that it requires a subspecialty in urology or oncology in order to evaluate evidence. Each member of the USPSTF is trained in the evaluation of evidence.