What you’re not being told about ‘free’ public head and neck cancer screening events

‘Tis the season of oral, head, and neck cancer screenings, with a plethora of free public events taking place at health clinics and hospitals all over the country right now.

Judging by the abundant and largely uncritical news coverage, it’s been a major PR win for the Head and Neck Cancer Alliance, which runs the trademarked “Oral, Head and Neck Cancer Awareness Week” and states it “promotes a high volume of free screenings all over the world.”

As we’ve said before and will say again, public screening events deserve a harder look from news outlets. One of the biggest pieces of misinformation touted at these events is that screening saves lives. But as the US National Cancer Institute explains in its page on oral and oropharyngeal cancer screening, “No studies have shown that screening would decrease the risk of dying from this disease.”

To help foster more thoughtful public discussion on this issue, six years ago we recommended journalists explore these three questions as a starting point, and they’re still relevant:

1. What exactly is going to be screened (there’s a lot of anatomy in the combined oral-throat-head-neck region) and how?
2. Is there any evidence that such screening saves lives?
3. Are there any widely adopted medical guidelines on such screening? If not, why not?

Yet, in our look at numerous local news stories about oral/head/neck cancer this week, no one answered these questions. (Readers: If you do see one that does so, please send it our way–we’d love to shine a light on them!)

Who pays for follow-up visits from these public screenings?

In this era of volatile health costs and increasingly spotty health insurance coverage, there’s another topic journalists should be broaching.

“The problem with health fairs is that they often do not … ensure that people getting screened actually have the resources to be further evaluated or treated for any problems that are identified through screening,” said Richard Hoffman, via email. Hoffman is a professor of Internal Medicine and Epidemiology, and Director of the Division of General Internal Medicine for the University of Iowa Carver College of Medicine/Iowa City VA Medical Center.

Dr. Virginia Moyer, former member chair of the U.S. Preventive Services Task Force, concurred.

“The screening may be free, but an appointment with a specialist at a hospital is really expensive–not just the physician’s fee, but also the “facility fee” (which private offices can’t charge) and that often doubles the total bill,” said Moyer via email, who is the Vice President for Maintenance of Certification and Quality at the American Board of Pediatrics. “And then there is the money to be made on imaging.”

As this op-ed explains, cancer screening is a lucrative business. For this reason, we suggest journalists ask a fourth (and two-part) question: If a suspicious lesion is detected at a screening event, who is responsible for ensuring a person receives follow-up care? And who pays for that care?

What about shared decision-making?

Another problem with public screening events is the lost opportunity for shared decision-making. Ideally, before a person agrees to any medical service, they’re informed of the evidence-based benefits and risks (including costs of treatment). They’re told what it will take to analyze a suspicious-looking spot; how often such spots turn out to be nothing; and what harms might occur along the way. Should they agree to treatment, they’re (ideally) also guaranteed access to a medical provider to help with decision-making. These are things that don’t happen as a matter of course at mass screening events, but should–and journalists need to point that out.

The news stories we looked at instead focused on the number of people diagnosed each year, the signs and symptoms to look out for, and known risk factors–framing that’s strikingly similar to the PR materials put out by the Head and Neck Alliance. Examples include these stories from Fox News Carolina, The Herald-Dispatch in Huntington, N.Y., The Chronicle in Orange County, N.Y., ArkLaText.com News in Shreveport, La., and The Connecticut Post.

News-6 Orlando was one of the few news outlets that went beyond the news release materials and interviewed a patient and a surgical oncologist, and discussed symptoms and some risk factors. The Maui News, meanwhile, focused on one man’s struggle with oral cancer, and didn’t promote free local screening. It also wisely recommended a Cancer.gov link for people to read more.

On the surface, public screenings like this communicate compassion, caution, and common sense prevention by sponsors who clearly have your best interest in mind. But are there other interests at play? If you’re a journalist, is it cautious and compassionate to uncritically promote screening–and all that it could lead to–if the evidence, so far, is lacking?