Sheryl Crow hawks 3D mammograms with fear and false hope

Kevin Lomangino is the managing editor of HealthNewsReview.org. He tweets as @Klomangino.

It may not be her favorite mistake, but it was a mistake nonetheless for the singer and breast cancer survivor Sheryl Crow to advocate in an aggressive, unbalanced way on behalf of a 3D mammography device.

That’s the takeaway of a number of breast cancer experts who’ve reviewed the content of the manufacturer-sponsored “education campaign” and Crow’s statements regarding breast cancer screening. They found blatant abuse of statistics and misleading guidance about the appropriate role of mammography screening in breast cancer prevention and treatment.

650x350_sheryl_crow_banner

An obligation to market responsibly  

“Celebrities need to recognize that they are not experts, and their experience does not reflect that of the general population,” said Deanna Attai, MD, an assistant clinical professor of surgery at the David Geffen School of Medicine at the University of California Los Angeles and immediate past president of the American Society of Breast Surgeons . “A celebrity endorsement or statement, especially related to a disease so prevalent as breast cancer, carries weight. I certainly understand from the corporate standpoint the desire to use a popular celebrity to endorse their product. However, companies as well as the media have a responsibility to market their products and technology in ways that are not misleading to the general public.”

According to a news release from Hologic, the Marlborough, Massachusetts-based company that markets the Genius™ 3D MAMMOGRAPHY™ exam, Crow will act as “celebrity spokesperson” for the company’s campaign that will include “a satellite media tour and social media outreach.”  Among the statements that Crow and Hologic share with readers are the following:

  • “It’s wonderful to be aligned with a technology that women may or may not know about – it’s a 3D MAMMOGRAPHY™, the Genius™ 3D MAMMOGRAPHY™ exam. It’s proven to detect breast cancer 15 months earlier than any 2D mammography.”
  • “Early detection saves lives — it’s that simple. Women need to be advocates for their health, and that means getting annual mammograms starting at age 40 and taking advantage of the best, and most accurate, technologies available. I opted for a Genius™ exam because early detection is what saved my life — it’s a woman’s best chance at survival, and it’s a chance we all deserve.”
  • “One in every eight women will develop breast cancer in her lifetime, but if caught early, the five-year survival rate is nearly 100 percent.”

Early detection — it’s NOT that simple

Experts emphasized that guidance around mammography is actually much more complicated than Crow’s message of “early detection saves lives.” As Dr. Attai explained, while 3D mammography may well improve the rate of early breast cancer detection, especially in women with dense breast tissue, the absolute increase in cancers detected is small and the increased detection rate comes at a price.

“Unfortunately, as mammography technology improves to provide us with clearer pictures, we also wind up detecting things that may be of little or no clinical significance, but result in the recommendation for biopsy and/or treatment. This includes benign lesions, high risk lesions, and some cancers,” she says.

In other words, a woman’s “best chance at survival” — as Crow describes early detection with 3D mammography– may not be much better than the alternative of conventional 2D screening or even no screening. And that incremental benefit needs to be weighed against the potential for increased harms from unnecessary treatment — something never addressed in the Hologic promotional materials.

“An early diagnosis does provide more options for care,” said Christine Norton, a patient advocate with the Minnesota Breast Cancer Coalition. “But an early diagnosis may be overdiagnosis. Recent research has shown that some breast cancers will never progress and some even disappear without any treatment at all. The KEY problem is definitively determining which breast cancers will progress and therefore must be treated and which breast cancers will not progress and can be watched but not treated. I wish more focus were on solving that problem.”

It is well recognized that some cases of ductal carcinoma in situ (DCIS), a type of precancerous lesion, may never pose a threat to the patient but are often treated aggressively. Treating these lesions may not be beneficial but exposes women to potential harms from unnecessary chemotherapy, radiation, and surgery.

Advocate AnneMarie Ciccarella, who blogs at ChemoBrainFog and was profiled recently in a HealthNewsReview.org podcast, also called the focus on early detection inappropriate. “To those whose disease was caught early and still metastasized outside the breast, this [early detection] messaging is insulting. To the rest of us, it’s misleading. Using a celebrity spokesperson for new technology … I have to question if we are feeding the misguided notion that we should be getting our medical information from a celebrity rather than the science community and our clinicians.”

Abuse of statistics: Fear-mongering and false hope

The Hologic campaign also trots out tired statistics that have been thoroughly debunked and are misleading. For example, the claim that “One in every eight women will develop breast cancer in her lifetime” vastly overstates the risk that most women face. Suzanne Hicks, also an active member of the National Breast Cancer Coalition, pointed to an analysis of that statistic from the Dr. Susan Love Research Foundation which notes: “[the 1 in 8 statistic] is one of the most misunderstood breast cancer statistics. [It] doesn’t accurately reflect the average woman’s breast cancer risk. Age is the most important risk factor for breast cancer, so as a woman gets older, her breast cancer risk increases, approaching a one in eight risk after age 70.”  At age 40, the risk is “1.45 percent (or 1 in 68).”

And what about the idea that early detection leads to a five-year survival of “nearly 100 percent”? That’s another whopper. In fact, “If there were an Oscar for misleading statistics, using survival statistics to judge the benefit of screening would win a lifetime achievement award hands down,” noted Drs. Steve Woloshin and Lisa Schwartz in a 2012 BMJ commentary.

The “nearly 100% survival” statistic is flawed and “generates false hope about the benefit of mammography screening,” Woloshin and Schwartz wrote. The first problem they point to is lead-time bias in survival outcomes. Aggressive screening finds cancers earlier than they otherwise would have been detected, which leads to higher survival at 5 years compared with no screening even though patients may not actually live any longer than patients whose cancer was identified at a later stage. Overdiagnosis — detection of non-invasive or slow-growing cancers that would never actually cause symptoms or death — also plays into it. The more patients who are overdiagnosed with cancers that don’t need to be treated, the higher the survival rate will be.

Dr. Attai told me that in her opinion, “it is never appropriate to include cases of ductal carcinoma in situ (DCIS) when discussing breast cancer mortality, and thus I find this [nearly 100% survival] statement very misleading. The breast cancer specific and overall survival rates for DCIS approach 100%, often regardless of treatment (or lack of treatment). When physicians discuss ‘early stage’ breast cancer, we are generally referring to Stage I and II invasive disease. Survival rates for these early stage invasive breast cancers vary depending on stage as well as tumor biology. As we learn more about tumor subtypes and tumor biology, it is becoming clear that stage at diagnosis is only one factor impacting breast cancer survival rates, and in some cases, it may not be the most important factor.”

Spare us the encore

This isn’t the first time that Crow has been called out for giving simplistic advice to women about breast cancer screening. In a 2014 AARP profile where she called her cancer diagnosis “a gift,” she also gave a blanket recommendation for regular mammograms that some breast cancer patient advocates found wanting.

In the new Hologic campaign she calls for all women to get regular mammograms at age 40 — a statement that conflicts with evidence-based screening guidelines from the US Preventive Services Task Force and American Cancer Society (ACS). These organizations recommend, respectively, that screening be done regularly starting at age 50 or 45, and that women at average risk be encouraged to have “a discussion of screening around the age of 40 years” that includes “information about risk factors, risk reduction, and the benefits, limitations, and harms associated with mammography screening” (ACS recommendation).

Women might reasonably choose to start mammograms at age 40 and some organizations endorse that starting point. But no matter the recommendation, any discussion of mammography should be more nuanced than the “get screened” message that Crow is putting out there. And it can’t be ignored that this simplistic message happens to dovetail nicely with the interests of the company she’s being paid to promote.

Crow is a prolific endorser of products ranging from hair coloring to the Wall Street Journal. But breast cancer screening isn’t something anyone should be hawking with simple slogans and trumped up statistics.

As advocate Suzanne Hicks told me, “Just as not all women are successful entertainers, not all cancers are equally risky.  Risk factors…..gender, age, race, etc……should be the focus of the doctor/patient partnership, not a technology promotion campaign.”

You might also like

Comments (7)

We Welcome Comments. But please note: We will delete comments left by anyone who doesn’t leave an actual first and last name and an actual email address.

We will delete comments that include personal attacks, unfounded allegations, unverified facts, product pitches, or profanity. We will also end any thread of repetitive comments. Comments should primarily discuss the quality (or lack thereof) in journalism or other media messages about health and medicine. This is not intended to be a forum for definitive discussions about medicine or science. Nor is it a forum to share your personal story about a disease or treatment -- your comment must relate to media messages about health care. If your comment doesn't adhere to these policies, we won't post it. Questions? Please see more on our comments policy.

Mark Foster

July 19, 2016 at 9:33 am

For years, the ACS urged women to start mammograms at age 40, then shifted its guidelines to 45 about 10 months ago. Meanwhile, the U.S. Preventive Services Task Force Services (USPSTF) says that women can wait until 50. Other groups, such as the American College of Obstetricians and Gynecologists (ACOG), say that starting at 40 is best as well as the European Institute of Oncology. Who is right?
Anyway, i don’t think it’s a terrible advice suggest to start mammograms at early 40.

Peggy Sue Carpenter

July 19, 2016 at 3:09 pm

I respectfully disagree with the headline of this article. I don’t see the marketing as fear mongering, but instead a way to promote a new technology that can detect the possibility of a tumor. I think it’s wonderful that our technology is constantly improving. And while some biopsies turn out to be nothing, isn’t it simply the patient’s right to have a choice in knowing if their tumor is benign or not? You have to be your own health advocate in this day and age, and knowledge is power. Some cancers are aggressive no matter how large the mass may be. From my experience, the “wait and see” advice is more fearful than the possibility of carrying a deadly cancerous tumor around inside and not knowing it.

Kevin Lomangino

July 19, 2016 at 5:04 pm

Thanks for your comment and allow me to respectfully disagree in turn. There’s no problem with promotion of a new technology that can detect the possibility of a tumor. The problem is when that promotion misleadingly oversells the benefits of early detection with debunked statistics and neglects to mention important harms that may occur. Knowledge is power, I agree, and this campaign doesn’t foster it.

Kevin Lomangino
Managing Editor

Kevin Lomangino

July 20, 2016 at 2:12 pm

The problem Mark is that she’s not “suggesting” — she says “getting annual mammograms starting at age 40” is simply what women should do. The ACOG position is much more nuanced than “get screened at 40” as reflected in this January 2016 statement. “ACOG strongly supports shared decision-making between doctor and patient, and in the case of screening for breast cancer, it is essential. Given the differences among current organizational recommendations on breast cancer screening, we recognize that there may be confusion among women about when they should begin screening for breast cancer. ACOG encourages women to discuss this with their doctor, including concerns such as family history of cancer, risk factors such as overweight, and their own personal experiences with breast cancer. Moreover, it is essential that physicians counsel women about the potential consequences of mammography, including false positives.

Peggy Sue Carpenter

July 20, 2016 at 8:20 pm

I guess this is where I am confused about the article. What would be considered an appropriate campaign for an expensive 3D mammogram? I don’t think many healthplans would allow a patient to come in demanding a mammogram because of Sheryl Crow. However, the spotlight of her celebrity status grabs attention, provokes thought, and sparks interest which sparks conversation, which advocates awareness and allows for the patient/doctor conversation to be had. Yes, all cancer screening may lead to false positives. In fact, isn’t that what they always say? “It’s probably nothing.” I remember those words vividly. In the case of AnneMarie, all cancer survivors live in fear of recurrence, but a large majority of dx are able to be resolved from early testing. The more a tumor grows the more aggressive treatment is required and recurrence becomes a greater threat. A few biopsies are nothing compared to chemo and daily radiation. I hate to think how AnneMarie’s situation would be different had it not been for early detection (twice now) due to preventative screening of her disease, for which she is now NED.

Ann Smith

July 20, 2016 at 10:29 pm

Lomangino is mostly right. Except that he presents the American Cancer Society in a positive light when it’s one of the most shady, deceptive, and damaging pawn companies for corporate medicine.

This particular “education campaign” starring Crow is just one of thousands such false and deceptive advertising campaigns for a highly profitable product of corporate medicine over the last several decades. The gullible general public hasn’t figured out that this is little more than sleazy salesmanship disguised as “science” and “education.”

But in one way you can’t blame them… they’ve been hypnotized by the disinformation of the glorified orthodox medical business since they’re born. They don’t know even half of what’s really going on…

Therefore, celebrities are pretty much just like the general public and commonly promote the mainstream medical narratives and slogans they’ve heard a million times (“mammograms save lives”, etc etc etc) without EVER actually scrutinizing these claims. (Much of the posted comments here totally prove this vast ignorance among the public at large.)

The cancer business and its well-paid members such as Komen and the American Cancer Society have long used “blatant abuse of statistics and misleading guidance” and fallacies, half-truths and lies in the promotion of their lucrative products and procedures (read the well referenced epilogue of an article on the ‘war on cancer’ if you google “A Mammogram Letter The British Medical Journal Censored” and scroll down to the afterword).

But…..IF…….. women (and men) at large were to examine the mammogram data above and beyond the information of the mammogram business cartel (eg American Cancer Society, National Cancer Institute, Komen, the medical profession), they’d also find that it is almost exclusively the big profiteers of the test, ie. the “experts,” (eg radiologists, oncologists, medical trade associations, breast cancer “charities” etc) who promote the mass use of the test and that most pro-mammogram “research” is conducted by people with massive vested interests tied to the mammogram industry. Hologic is the maker of the 3D machine… go figure.

Contrary to the official narrative (which is based on medical business-fabricated pro-mammogram “scientific” data), there is marginal, if any, reliable evidence that mammography, whether conventional or 3D mammography, reduces mortality from breast cancer in a significant way in any age bracket but a lot of solid evidence shows the procedure does provide more serious harm than serious benefit (read: ‘Mammography Screening: Truth, Lies and Controversy’ by Peter Gotzsche and ‘The Mammogram Myth’ by Rolf Hefti).

Most women are fooled by the misleading medical mantra that early detection by mammography saves lives simply because the public has been fed (“educated” or rather brainwashed) with a very one-sided biased pro-mammogram set of information circulated by the big business of mainstream medicine. The above mentioned two independent investigative works show that early detection does not mean that there is less breast cancer mortality.

Because of this one-sided promotion and marketing of the test by the medical business, women have been obstructed from making an “informed choice” about its benefits and risks which have been inaccurately depicted by the medical industry, favoring their business interests.

Operating and reasoning based on this false body of information is the reason why very few women understand, for example, that a lot of breast cancer survivors are victims of harm instead of receivers of benefit. Therefore, almost all breast cancer “survivors” blindly repeat the official medical hype and nonsense.

Misguided celebrities are among the favorite marketing tools of the corrupt cancer industry.

Stephen Cox, MD

July 26, 2016 at 1:30 pm

In response to Anne Smith, there are pros and cons to most screening technologies, including less expensive ones, that should be discussed with patients. Many patients or family members will vehemently disagree with her, based on their anecdotal experiences and this complicates counseling. It would be helpful to see responses to her accusations from experienced clinicians. It seems feasible that some groups benefit from exaggerated promotions, but I am not sure how oncologists would since they do not get involved unless cancer exists and needs assessment.