[Editor’s note: Officials from the University of Michigan have commented in response to this post; scroll to the bottom to view their statement. And, in an addendum of March 17 below, we note that two American Society staffers criticized the study for “egregious biases.”]
Disagreements over guidelines for cancer screenings have reached a state of near chaos. There’s so much confusion over the competing recommendations for when women should have mammograms that the American College of Obstetricians and Gynecologists (ACOG) is hosting a summit of sorts this week among the different guideline sponsors to come to some kind of consensus.
But even when PR news releases are careful not to take advantage of the “hotness” of a topic, subtle changes in emphasis can twist the main message of a piece of research and lead to downstream changes that can really confuse and misinform readers. A recent example is when researchers shared findings from a study published in the American Cancer Society’s journal, Cancer, that found 15% of colorectal cancers occurred in people under age 50. One of two news releases issued about the research was very careful not to use the finding to make recommendations for earlier screening than exists in current guidelines.
The University of Michigan news release proactively addressed the screening issue by asking its lead researcher to answer the question: “Should guidelines change to begin screening at an earlier age?”
Hendren says not so fast. “This would be a big and costly change, and I don’t know whether it would help more people than it would hurt,” she says. “A lot of research would be required to understand this before any changes should be made.”
In its release on the same study, Wiley (publisher of Cancer) took a slightly different tack which hinted that the recommendations may be missing “many” patients. “Many colorectal cancer patients are younger than the recommended screening age,” is the headline on its release.
In any event, the trail of news coverage is a case study in how messages tend to morph. In its coverage, HealthDay qualifies the findings with the subhead: “Though guidelines suggest screening starts at 50, researcher says it’s premature to change them.”
But in STAT’s story, headlined “Colonoscopy at 40? Study finds possible benefit,” the lead researcher’s caution about jumping the gun on revising the guidelines appears to have melted away.
But Dr. Samantha Hendren, who coauthored the paper, said those guidelines might cause doctors to miss a significant number of ill patients.“I have had patients under 50 coming to me, saying, ‘I’ve had symptoms for a year,’ and their doctors told them it was nothing to worry about,” said Hendren, a cancer researcher at the University of Michigan. “My hope is that this paper will spur epidemiological research on the cost versus the benefit of testing sooner.”
Did Dr. Hendren indicate that her study found “a possible benefit” to screening at 40 as the STAT headline suggests? It’s certainly possible that she did; we have no way of knowing whether that headline reflects an accurate representation of Hendren’s comments to STAT. But her quotes in the story itself say only that she hopes for additional epidemiological research on the question. And the “possible benefit” message is clearly at odds with her messaging from the careful university news release.
Incredibly, by the time NY Daily News (NYDN) picked up the article via STAT (referring to the STAT news portal as a “medical journal”), the message about the research had turned a full 180 degrees.
“Doctors should be screening for colon cancer far earlier than they do now, according to a new study,” says the NYDN article. “In fact, patients who develop colorectal cancer younger than 50 often are diagnosed late in the game because doctors did not think to test them for a cancer usually found in older people, researchers said Monday in published the journal “Cancer.”‘
From “This would be a big and costly change, and I don’t know whether it would help more people than it would hurt,” to “Study suggests lowering the age for first colonoscopy to 40” as the NYDN headline states, is a huge leap indeed.
How are news consumers supposed to make any sense of this?
We reached out to University of Michigan communications officials for a comment about this situation and received the following response:
We appreciate HealthNewsReview.org’s attention to how this new research was covered by the media. We too found it interesting and distressing that some of the headlines and news coverage of this study suggested the need to begin colonoscopy screening at an earlier age.
The key finding of this paper is that a significant number of colorectal cancer patients are diagnosed before age 50, the age at which screening is recommended.
In the paper, we suggest the following regarding screening:
“For the screening of average-risk patients, the increasing rate of early-onset CRC would suggest that we should consider low-cost/low-risk screening with fecal immunochemical test kits or fecal DNA tests for the entire population at an earlier age (eg, age 40 years or 45 years). The cost-effectiveness of such a strategy could be tested formally in future studies.”
Because there is not a clear message to begin screening at an earlier age, we chose to focus our university press release on the need to increase awareness of early warning signs of colorectal cancer. This study suggests it’s important not to dismiss these signs in younger patients. That is something that physicians and consumers can and should act on immediately.
In addition, we urge more emphasis on identifying those who are at higher risk of colorectal cancer by encouraging discussion and identification of family history. We also recommend more resources for younger colorectal cancer survivors, as the study suggests this is becoming increasingly important.
As far as screening, more research is needed to understand the risks and benefits of beginning colorectal cancer screening at an earlier age. At this point, people at average risk should follow the current guidelines of beginning routine colonoscopy screening at age 50.
Cancer screening research findings and guidelines are important for the mass media to cover, because media attention has the power to change the public’s behavior for the better. But the dangers of inaccurate coverage, or jumping to premature conclusions, are equally real.
Samantha Hendren, M.D., MPH
Associate Professor of Surgery
University of Michigan Medical School
Manager of Cancer Communication
University of Michigan Comprehensive Cancer Center
Kathlyn Stone is an associate editor with HealthNewsReview.org.
Publisher’s addendum on March 17: Another twist on this. Two American Cancer Society staffers wrote a followup letter to the Cancer journal, where the paper was published. Excerpt:
“However, there are 2 biases in (the authors’) calculation. The most egregious is the unexplained exclusion of patients aged ≥80 years at the time of diagnosis, who represented 24% of colorectal cancer cases in this cohort. Second, patients that had any previous or subsequent cancer diagnosis, representing approximately 10% of cases aged 50 to 79 years, also were excluded. The actual percentage of microscopically confirmed CRC cases diagnosed among individuals aged 20 to 49 years in the 13 Surveillance, Epidemiology, and End Results registries that collected data continuously between 1998 and 2011 was 9.7% (23,970/247,865). Perhaps more interesting is that this percentage increased over time, from 8.3% in 1998 to 11.6% in 2011, despite the fact that the percentage this age group represented in the adult population decreased from 65.3% to 57.7%.”
And the researcher-authors wrote back and, at least partially, agreed with that criticism:
“Our study excluded patients who were aged ≥80 years; this exclusion indeed increased the percentage of cases among those too young for average-risk screening from approximately 10% of all comers to 15% in our cohort. We excluded patients aged ≥80 years a priori for 2 main reasons. First, treatment inherently differs in these patients due to patient preferences, advanced age, multiple comorbidities, and the fact they are underrepresented in clinical trials. Second, screening elderly patients in this age group is controversial and not routinely recommended. Although the American Cancer Society does not set an upper age limit for screening, the US Preventive Services Task Force and the American College of Physicians do question screening after age 75 years in patients whose prior screening was negative. Thus, limiting our cohort was in keeping with our primary research questions and design aimed at comparing the stages, treatments, and outcomes between populations for whom average-risk screening is and is not routinely recommended. …
We appreciate the epidemiologic clarity added by (the ACS staffers who wrote the critique), and we believe that the clarifications of our a priori exclusion criteria in this letter were essential to support the conclusions. We echo their sentiments that we hope this study will help increase awareness of the increasing number of young patients with colorectal cancer, and of the need for individuals at increased risk to begin screening at a younger age.”
We will end as we did in an earlier version: How are news consumers supposed to make any sense of this?