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Stories lament ‘delay’ in getting a mammogram after a false-positive scan, but is that such a bad thing?

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

A study published last week suggests that false-positive mammogram results take a psychological toll on the women who receive them.

In fact, the effects may be so distressing that some women may wait longer before getting their next mammogram, the researchers say. Here’s the CBS coverage from a local Chicago affiliate:

The study of more than 250,000 women by researchers at the Russell Institute for Research and Innovation at Advocate Lutheran General Hospital in Park Ridge found 50% of women who get a false positive result from a mammogram are not likely to return for another screening for 25 months—13 months later than recommended.

Hold on a second: Whose recommendations are we talking about?

As the CBS story suggests, some groups recommend annual breast cancer screening for women as young as 40.

But the U.S. Preventive Services Task Force (USPSTF) recommends that women start mammograms at the age of 50 and get them every other year (every 24 months) until they reach 75. That’s about the same interval (25 months) that the CBS story frames as a “delay” in getting a mammogram.

So maybe that’s not a “delay” at all.

Maybe that’s just more women deciding that the anxiety produced by these false-positive scans outweighs the small chance that they will benefit from the intervention.

Maybe these women are actually making a thoughtful, evidence-based decision to get screened less frequently so that they are less likely to receive a false-positive result.

HealthDay’s unbalanced coverage of the study didn’t allow for that possibility. It warned that women who waited longer were making “a potentially fatal mistake,” and trotted out the misleading slogan that “detecting tumors early can save lives.” Here’s their quote from an expert source:

“Unfortunately, for women over age 50, just skipping a mammogram every other year would miss up to 30 percent of cancers,” said Dr. Stefanie Zalasin, a breast imaging specialist in New York who reviewed the new findings.

What about overdiagnosis?

Sorry, but you can’t talk about missing 30% of cancers without also mentioning the risk of overdiagnosis. A little over a month ago, we reported on a study showing that a substantial portion of screen-detected breast cancers don’t need to be treated. These slow-growing cancers may never cause the patient any trouble. Yet, women diagnosed with such tumors may be possibly exposed to harms from radiation, chemotherapy and surgery.

As counterintuitive as it sounds, “missing” some of these cancers – and avoiding the subsequent unnecessary treatment – might well be the best outcome in some cases.

But neither the CBS nor the HealthDay coverage went there. Nor did either story note the discrepancy in mammography screening recommendations between the American Cancer Society (which recommends annual mammograms starting at 45) and the USPSTF (which recommends mammograms every other year starting at 50). (Generally speaking, organizations with a financial interest in mammography tend to issue more aggressive screening guidelines.) Both stories leaned heavily on the lead author, Dr. Firas Dabbous, who according to CBS said that women scared by a false-positive “need to be educated about just how vital mammograms can be.”

Perhaps those women were educated – and maybe they decided that mammograms weren’t as vital as they’d been led to believe.

“I wish that HealthDay gave women the benefit of the doubt,” Dr. Deanna Attai, a breast surgeon and editorial contributor to HealthNewsReview.org told me. “There is no way to know why the women who had a false positive did not continue with annual screening. Perhaps they were ‘spooked’ by the callback and biopsy process. But it is also possible that going through the additional procedures prompted a conversation between the patient and her physician regarding the potential downsides of annual screening and these women made an educated decision regarding future imaging.”

Stories that included more context

Not every story that covered the study was as imbalanced as the preceding examples. For example there was this helpful context from NBC:

How often women should get mammograms is a controversial topic and not every tumor is a killer.

Just last October, at the Dartmouth Institute for Health Policy and Clinical Practice said overdiagnosis was causing women worry and treatment that may be more harmful than some of the tumors being removed.

[Note: The NBC story appears to be referring to Dr. Gilbert Welch in the above paragraph, though no source for the statement is provided.]

Last month, American Cancer Society chief medical officer Dr. Otis Brawley argued that not every breast tumor is a killer and shouldn’t be treated as such.

American Cancer Society guidelines say women with an average risk of breast cancer can wait until they’re 45 to have a first mammogram and should have them every year until age 55. After that they should start having them every other year.

The U.S. Preventive Services Task Force says most women can safely wait until they are 50 to start getting mammograms and that they need only one every other year.

I wish that more stories had stepped back and questioned what these results really tell us.

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