Kevin Lomangino is managing editor of HealthNewsReview.org. He tweets as @KLomangino.
Colon cancer is on the decline, and you’d be forgiven for thinking that colon cancer screening — and the increased adoption of colonoscopies in particular — is the reason.
Promotion of colonoscopies, a market worth more than $10 billion annually in the United States, is everywhere:
• In March, the Mayo Clinic’s social media director underwent a colonoscopy viewable live on the mobile app Periscope — an event covered unquestioningly by health news site STAT.
• Journalists like Katie Couric and Harry Smith have crusaded for colonoscopies in front huge national TV audiences — abdicating their professional responsibility to objectively vet claims of evidence.
• Advocacy groups are pushing vigorously to reach an 80% screening goal by 2018, even though screening is a preference-sensitive decision that an informed patient might reasonably decline.
• Public health agencies have splashed one-sided, pro-colonoscopy messages across billboards — and received one-sided, pro-colonoscopy coverage of their campaigns from some journalists.
But are colonoscopies really the driving force behind the colon cancer success story?
An editorial in the New England Journal of Medicine raising that question got no attention from health care journalists last week (at least none that we could find). We were alerted to the piece, written by Drs. Gil Welch and Douglas J. Robertson of Dartmouth University, by the comments from two smart physicians on Twitter, both of whom called attention to the editorial’s insightful closing paragraph:
Drs Welch & Robertson call for humility about the benefits of Ca screening. Last paragraph sizzles w wisdom https://t.co/c2oCzVipWg
— John Mandrola, MD (@drjohnm) April 27, 2016
Brilliant ending. Calling health journalists and PR staff… CC @HealthNewsRevu @garyschwitzer @ivanoransky https://t.co/olSl2ZIghz — Steven Tucker, MD (@drsteventucker) April 27, 2016
The paragraph they pointed to includes this nugget:
…overstating the benefits of colorectal-cancer screening may divert attention from colonoscopy’s downstream effects and potential harms. The majority of people undergoing screening are neither identified as having cancer nor protected from its developing, but they often endure repeated colonoscopy for surveillance of small polyps. Certainly, aggressive efforts to screen and perform follow-up colonoscopy in persons who are most likely too old or infirm to benefit has real potential to cause harm.
Why shouldn’t screening get all the credit for reducing the burden of colorectal cancer?
For one thing, the decline began showing up well before the benefits of increased screening would be expected to take effect, Welch and Robertson say. And the decline has been bigger than the effect found in any colon cancer screening trial — suggesting that screening can’t be entirely responsible. They also name a number of other plausible explanations such as better diets and more effective cancer treatments. You should read the entire piece to get the full flavor of their argument.
There’s nothing wrong with organizations wanting to advocate for more colon cancer screening awareness. But truly informing the public is different than mindlessly promoting a procedure. Journalists who cover these campaigns should always strive to provide context and avoid cheerleading. They should discuss costs, harms, and alternatives, and acknowledge that the evidence supporting colon cancer screening isn’t as bullet-proof as it’s sometimes portrayed.
We’ve made a point of calling attention to respected voices who question the evidence on colonoscopies when seemingly few others were doing so:
The editorial by Welch and Douglas was another missed opportunity for journalists to highlight some of this context.
Comments (4)
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Brad Flansbaum
May 4, 2016 at 7:53 amIts hard to advocate for more chemo and surgery as a means to improve outcomes. As for diet, I think we can cherry pick “diet” success and U.S. nutritional composition for the means we seek. However, if we had to summarize what the American public has been consuming the last three decades, I would not assign a high grade. You could find whatever you want to justify a good or bad ends. I think aspirin and NSAID explanation has real merit, but unfortunately because of space limitations, Welch could not flush out.
The graph is compelling and there are probably more factors at work, but heck, if its cutting and drugs which were the primary drivers, we need to temper conclusions. But yes on flex sig and FOBT–that we can agree.
Said Goueli
May 8, 2016 at 12:31 amI disagree with your assumptions that screening has not improved the health risk of developing colon cancer, In fact, this is one cancer that has been used as a testimonial to block the development of adenoma to adenocarcinomas by removing those adenomatous polyps. Furthermore, the cancer can be also detected at earlier stage which makes it less deadly and amenable to treatment. I do not know how you believe that screening for colon cancer is worthless.
Kevin Lomangino
May 8, 2016 at 8:37 amSaid,
Thanks for reading and commenting. Please re-read my post and tell me where I called screening for colon cancer “worthless.” I did no such thing. I do believe that the benefits of colon cancer screening, and colonoscopy in particular, are often overstated in media messages. That doesn’t mean that colon cancer screening is worthless. I call for more balanced coverage of these issues in the news media so that consumers can make more informed decisions about their care.
Kevin Lomangino
Managing Editor
Laurence Alter
May 10, 2016 at 4:38 pmDear News Reporter/Staff Member:
Be eternally thankful if any human adult in the English-speaking world has even HEARD of “The New England Journal of Medicine.” (or “Annals of Internal Medicine” or “Archives of Internal Medicine” – and getting doctors to keep up with these journals). Your job is to alert lay people to their existence. Your job is to downgrade mediocre sources of information (typically radio call-in programs). Your job is to report your OWN biases in your reporting (ex.: have you had a personal test or screening in your medical article on screening, ETC)?
Yours,
Laurence
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