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Roundup of Media Messages on the New Mammogram Guidelines

The U.S. Preventive Services Task Force (USPSTF) unveiled a draft update to its guidelines on screening for breast cancer yesterday. The major media outlets all jumped in with coverage that — for the most part — did reasonably thorough jobs of fulfilling our criteria for health news stories.

And while we didn’t think there was enough contrast between the stories to justify individual systematic reviews of each outlet, there were certainly nuances and points of emphasis that differed with each reporter’s take. We thought it would be useful to link to the coverage and provide a high-level rundown of our observations. Readers are welcome and encouraged to add their own analysis of the coverage in the comments.

Reuters – New U.S. mammogram guidelines stick with screening from age 50

Reuters says the rollout of the new guidelines is going more smoothly than the 2009 version, and quotes experts who say the USPSTF messaging is more focused than it was 6 years ago. “They made it really clear this time around, unlike 2009, that the discussion between a woman and a clinician about breast cancer screening should begin at 40,” said Dr. Richard Wender, chief cancer control officer at the American Cancer Society.

Bloomberg – Mammogram proposal threatens to reignite screening battle

Bloomberg leads with the threat that the guidelines are “potentially opening the door for insurers to stop covering some mammograms.” And it quotes an American College of Radiology spokesperson bemoaning the potential financial impact on women who don’t have the means to afford mammograms. In the interest of balance and full disclosure, we’d love to have seen some context on the potential financial impact of fewer mammograms on the income of radiologists.

Associated Press – TASK FORCE: MAMMOGRAMS IN 40S A CHOICE, BUT DON’T SKIP AT 50

AP was one of the few outlets to call attention to the lack of evidence supporting 3-D mammography — a new element of the 2015 USPSTF recommendations: “There’s not enough evidence to tell if new 3-D mammograms are the best option for routine screening, or if women with dense breasts need extra testing to find hidden tumors, the U.S. Preventive Services Task Force concluded.” AP said that in other respects, the guidelines are “largely a rewording of the task force’s controversial 2009 recommendation that drew protests for questioning the usefulness of mammograms in the 40s.”

NPR – Federal Panel Revisits Contested Recommendation On Mammograms

NPR frames the updated guidelines through the personal lens of the reporter (a woman in her 40s) who is debating whether to get a mammogram.  It’s an insightful approach, bringing a much-needed patient perspective to the clinical weighting of benefits and harms:  “I now have a young daughter, and my fear of dying prematurely has become far, far stronger than my fear of getting chemo or even a mastectomy I might not need,” says reporter Katherine Hobson. “I understand the statistics, but I’d feel like a total jerk if I didn’t get screened and that unlucky statistic were me.”  However, we wonder if the story too casually dismisses the harms of overdiagnosis, and accepts (with no documentation) that overtreatment of carcinoma in situ will soon become avoidable. “In the not-so-far future, molecular tools may help physicians give those women a more accurate prognosis, Wender says, so those at lower risk can opt for less aggressive treatments — or simply watchful waiting.”

USA Today – Women in their 40s should consider mammogram every other year, group says

While all of the studies we looked at featured some quantification of the benefits and harms of mammography, USA Today earns kudos for this very helpful graphic representation of the numbers (click the graphic for a larger version).

mammogram graphic

We also appreciate the story’s inclusion of comments from Otis Brawley, Chief Medical Officer of the American Cancer Society, who explains the need for a better dialogue surrounding the risks and benefits of mammography. “People in the United States think that breast cancer screening is better than it is,” Brawley says. “We have done a poor job at explaining the limitations of mammograms.”

 

See also this additional coverage:

NBC News – U.S. Panel ‘Clarifies’ Mammogram Advice 

LA Times – To find breast cancer, more mammograms aren’t better, expert panel says 

Wall Street Journal – Mammograms Most Beneficial for Women 50 to 74, Panel Says 

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Comments (1)

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Phil Rodgers

April 25, 2015 at 7:08 am

I appreciate your coverage of an critically important topic. As a primary care physician, I have conversations about breast cancer screening with my patients every day.
I echo your commendation to USA Today for their graphic–I often use this framework with my patients (i.e. number needed to screen to save a life, unintended consequences, etc) for breast (and prostate) cancer screening, and it’s generally been very well received.
I would have liked, however, to see the USAT visuals broken out by age: specifically, a graphic for women between the ages of 40-49, and a separate one for women ages 50-74. Because the likelihood of mammography leading to a prevented breast cancer death rises with age, reporting stats without respect to age overestimates benefit to younger women, and underestimates benefit to older women.
This may seem picky, but it’s important, especially to my 40-50 yo patients (like the NPR reporter featured in the story), who struggle mightily with decisions to screen. Reading USAT, a 40 yo woman may think that her ‘NNS’ is as low as 120 to save her life (from the ‘8 lives saved with 1000 mammograms’), when even generous modeling shows that the NNS for women under 40-79 is ~750 (AJR, 2012). That”s before we have discussions about potential harms.
Again, thanks for your commentary – I just found out about HealthNewsReview, and will certainly be a frequent visitor!