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 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 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.
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 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.”
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).
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: