Reflection on one week of pro-screening biases in many media messages

We’re in the midst of what has been proclaimed prostate cancer awareness month, which has apparently also been proclaimed ovarian cancer awareness month. And next month is breast cancer awareness month.

Various media have joined in on the awareness efforts. But awareness of what?

In some cases – some seen just in the past week – journalists promote awareness of screening tests outside the boundaries of evidence or with an emphasis only on potential benefits while minimizing or completely ignoring potential harms.

First, I was pleased to see that the New York Times Well blog picked up on my post about NBC’s Andrea Mitchell’s breast cancer announcement – and the fact that many women with breast cancer were upset when they heard her say: “screening matters. Do it. This disease can be completely curable if you find it at the right time.” While sensitive and sympathetic about Ms. Mitchell’s diagnosis, these women questioned her use of a national television platform to deliver a message they felt was misleading.

Then, news coverage on a study pointing to benefits of screening mammography and of breast self-examination led Dr. Len Lichtenfeld of the American Cancer Society to write:

“You might imagine that-as an advocate of breast cancer screening and the value of early detection – I would be dancing in the streets as a result of this report.

Sadly, I am not.

In fact, if anything, I am concerned that the various representations of this study that I have read missed a fundamental point: this study reports information, but is not designed to answer the questions which the headlines and the press release suggest as the appropriate conclusions, namely that mammography and breast self-examination in women between the ages of 40-49 saves lives.”

David Sampson of the American Cancer Society blogged about:

“As National Breast Cancer Awareness Month draws near, you can feel the soft rumble of approaching awareness efforts, now unavoidably clothed in pink. For the past several years, the voices of those who question these efforts have become nearly as loud as those who support it. The rising din can make it a real challenge for consumers to know what to believe. It’s vitally important that all of us putting out messages about breast cancer be truthful about what we know, and just as important, what we do not.”

What we know and what we don’t know just wasn’t conveyed very well in two flawed big-time TV segments that made misleading, inaccurate statements about prostate cancer screening. One by ABC’s Good Morning America and one by WPIX-TV in New York.

And finally, Prevention magazine’s editor-in-chief advocated for ovarian cancer screening with transvaginal ultrasound, despite strong statements from evidence-based bodies that there is no reliable ovarian cancer screening test shown to save lives.

If you don’t track these trends systematically – as we do – you miss the pattern that they point to.

There isn’t any big conspiracy on the part of different media organizations to ignore evidence and to fail to explain that there are tradeoffs involved in any screening decision.

None of these organizations intends to do an incomplete job that may mislead or even harm people who hear or read these messages.

Nonetheless, there is a clear, albeit perhaps unintended, bias on the part of many news organizations and many journalists for telling incomplete stories about screening tests.

They just don’t get it. They don’t understand that all screening tests carry some potential for harm.

But there’s no excuse for it. And we will continue to address it whenever we see examples.

Recap:

• There is nothing in what I write that is anti-screening.

• There is nothing in what I write that would urge that anyone be deprived of the choice to be screened.

• My message is actually all about the importance of personal choice – shared-decision making choices between people and their doctors that includes a discussion about the tradeoffs of potential benefits versus potential harms in any screening decision.

• Many journalists fail to reflect those tradeoffs in their stories. That’s wrong and it is potentially harmful to public discussions and to personal decisions that may be impacted by the incomplete, imbalanced media messages.