A hospital wishing to promote its new 3-D mammography equipment couldn’t ask for much more than this: stories on Fox News, by WSB Atlanta, by WWMT in Kalamazoo, Michigan, in the Tulsa World, the Associated Press and Sacramento Bee and Charlotte Observer, the New York Daily News, and more.
It all happened because Mayor Gina Nobel of Stillwater, OK, announced in a news conference that 3-D mammography at Stillwater Medical Center saved her life. She said that the technology found an early Stage 0 cancer, or ductal carcinoma in situ – DCIS – a non-invasive form of cancer that many experts believe should not even be called a cancer.
One news story stated: “Mayor Noble serves on the board of the Stillwater Medical Center, so no one was more perfect to be the focus of a public service announcement encouraging women to get a mammogram using the hospital’s new 3D technology.”
Was she the perfect messenger?
Suzanne Hicks has been diagnosed with and treated for breast cancer. She has also been trained in the evaluation of evidence by the National Breast Cancer Coalition’s Project LEAD training program. And for several years she has been one of our periodic reviewers of media messages about breast cancer. She wrote to me:
“There are so many misunderstandings in this news coverage that it’s hard to know where to begin. My heart goes out to this woman who thinks she “has cancer”(Stage 0) , that her life has been saved, and that she can be assured 3-D technology “virtually eliminates the need for further testing.” As any breast cancer survivor knows, even the best diagnosis and treatment insure neither health nor life. And cancer is an illness that is monitored for the rest of life.
And by the way, what are the boundaries between politics, sales, and medicine here?”
That last point is one that jumped out at me immediately. A mayor, who sits on a hospital Board, is urged by the hospital to get a 3-D mammogram and then she ends up endorsing the hospital’s approach. That is a tangled web of conflicts of interest. And not a single journalist commented on it.
AnneMarie Ciccarella has also been diagnosed with and treated for breast cancer. She describes Mayor Noble’s news as “nails on a chalkboard” to her:
“The message from my oncologist at my first post-chemo appointment: “I will never say you are ‘cured’ because we just can’t know.” It’s very frustrating to watch people with a wide audience and a platform insisting that mammography and early detection is the holy grail of breast cancer. There are two things in play. The debate over DCIS and the fact that we can’t yet determine which ones would resolve on their own without any further medical intervention. The early detection, in this case, could have been overtreatment. On the flip side, mammograms don’t pick up every breast cancer. Every time someone in the public eye has an opportunity to use their experience as a teaching moment, they tend to lead the public down the ‘early detection saved my life’ road. Did it? It is possible for any early stage cancer to progress to metastatic disease which is still, for the most part, a terminal diagnosis. Instead of saying she definitively knows she won’t die of breast cancer, I’d suggest she should have stuck to the message I was told: “I just can’t know.”
I asked breast surgeon Deanna Attai of UCLA, past president of the American Society of Breast Surgeons, and one of our frequent editorial contributors, to analyze the news:
“I always get a little pit in my stomach when I hear phrases such as ‘a mammogram saved my life.’,” Dr. Attai wrote me. “This implies that early detection of breast cancer will result in a cure.”
Dr. Attai touched on the overtreatment issue, as Ms. Ciccarella did:
“In my practice, while the majority of patients are interested in taking advantage of technology to help improve cancer detection rates, a small but growing number are expressing concerns regarding overdiagnosis and overtreatment.”
She explains that survival rates (from breast cancer or overall) for women with DCIS diagnoses approach 100% regardless of whether a woman gets treatment or what type of treatment. Dr. Attai says 3-D tomography has been shown to improve cancer detection rates in patients with dense breast tissue, but that it has not yet been shown to improve the survival rates.
There were other issues in the news coverage that bothered Dr. Attai. Claims were made that 3-D mammograms “virtually eliminate” the need for additional imaging. She wrote:
“If a mass is seen, additional imaging such as ultrasound will still be recommended, and biopsy may be required for concerning masses or calcifications. That statement is very misleading.
The comment in one article that early detection means a woman is less likely to undergo chemotherapy or radiation is misleading and is false. The recommendation for chemotherapy is based on tumor stage as well as tumor biology. Some very small, early stage breast cancers are treated with chemotherapy due to the aggressiveness of the tumor and the likelihood of developing metastatic disease.”
Politicians and hospital marketing and gee-whiz journalism and breast cancer screening are not a good mix. As these stories show, it is a recipe for misleading information.