Sue Rochman is an independent health care writer and editor based in San Francisco. For more than two decades, she has specialized in covering cancer care and treatments.
There’s a reason mammograms are the perfect fodder for female comedians. There is little merriment in having your breast manipulated onto a table and then squeezed between square metal plates. But it does make for a good joke.
That 30-second window of discomfort is also a great marketing opportunity. Over the past few months we’ve seen two imaging companies and medical centers promoting new 3D mammography machines with patient-friendly comfort features that, they say, can transform the mammography experience into something that, as one radiologist put it, “is almost like a patient going to get a spa manicure [or] massage.”
It’s also a message that many news outlets have been more than ready to run with when a hospital in their area tells them they have one of these new machines. The most recent example: In Pennsylvania, Wayne Memorial Hospital’s news release about its new comfortable Senographe Pristina, which is made by GE Healthcare, was picked up almost verbatim by three local papers.
Why is this a problem? News organizations aren’t always providing context for the claims hospitals and companies are making about the new machines. They aren’t telling readers that the new machines haven’t been shown to save more lives than conventional 2-D mammography. They aren’t reporting that not all cancer screening guidelines recommend women start having mammograms at age 40. And they frequently perpetuate the false idea that pain is the number one reason women aren’t getting mammograms.
In Canada, the Globe and Mail ran an article earlier this month about St. Joseph’s Health Care in London, Ontario, which was the first hospital in the country to have a Senographe Pristina. The Globe and Mail story, though, goes above and beyond what we’ve seen in the U.S.—in a good way. It quotes Shawn Chirrey, senior manager of analysis at the Canadian Cancer Society, who points out documented reasons why women don’t get mammograms, such as “thinking they’re not necessary, simply not getting around to doing them, lengthy wait times, language barriers and costs in the form of transportation, childcare and taking time off work.” The article also tells readers about efforts underway to inform women about the limitations of mammography screening, and false positives, false negatives and overdiagnosis (that is, the detection of cancers that are so slow-growing that they would never cause a problem).
In the U.S., Hologic announced its “new SmartCurve™ breast stabilization system” last September with a news release claiming the new technology “has been clinically proven to deliver a more comfortable mammogram without compromising image quality.”
Three days later, the women’s magazine Shape posted an article about SmartCurve. The headline proclaims, “less torturous screenings mean more early detection and lives saved” while the article explains that Hologic’s 3D Mammography “has been shown to detect more invasive cancers and reduce false positives” and is “FDA-approved as superior to conventional 2D mammography for all women”—two phrases pulled verbatim from the release. To be sure Shape’s readers don’t miss out, the article links to a website where readers can “find the Genius 3D Mammography exam nearest you.” (We previously wrote about Hologic’s misleading 3D mammography campaign featuring singer and breast cancer survivor Sheryl Crow.)
September also saw GE Healthcare promoting its new Senographe Pristina Mammography System with “next-generation 3-D digital mammography” and “patient-assisted compression.” The pink machines have “gentle, rounded corners to help reduce discomfort and anxiety” and offer armrests instead of the typical handgrips. But that’s not all. Hospitals can buy a SensorySuite that “stimulates a woman’s senses to distract her from the perceived discomfort, pain, and anxiety of a mammogram.” During this spa-like “all-encompassing interactive experience” the air is infused with calming fragrances as flat-screen wall monitors display nature imagery, and relaxing sounds that match the imagery the patient has chosen are piped in.”
(The fact that these news releases were sent out in September shouldn’t be too surprising: October is Breast Cancer Awareness month, and a time when virtually every media outlet will run at least one breast cancer related story — many of which inappropriately cheerlead for more “early detection.”)
GE’s news release notes that the Christine E. Lynn Women’s Health and Wellness Institute at Boca Raton Regional Hospital in Florida was the first facility in the U.S. to install the system. On cue, in October, the Palm Beach Post ran a story about the hospital’s new 3D mammography system, in which Kathy Schilling, the institute’s medical director, touts its comfort and benefits, including better diagnostic results.
The Post story never explained, though, that there’s a reason for the discomfort: the more compressed the breast is, the better the image is likely to be. And none have noted that it doesn’t take long; each breast is compressed for a few seconds, two to four times. The entire appointment—from getting undressed to having the mammogram to getting dressed again—takes about 20 minutes.
Breast surgeon Deanna Attai, MD questioned whether women would see medical facilities that offer these new machines as somehow providing better procedures. “I would never expect any medical screening test to be similar to going to the spa for a manicure or massage,” she said. “Whether it is a mammogram, Pap test, or colonoscopy, this is what I want: an accredited facility; experienced, knowledgeable, and compassionate physicians and staff; prompt results; a clean facility, convenient hours and convenient parking.”
Attai said she was struck by the patronizing tone of the articles and the perpetuation of the belief that women are so scared of mammograms they need calming fragrances and a place to rest their hand so they don’t anxiously grip the machine. “To repeat a currently popular phrase,” she said, “I call BS.”
Even more importantly, the claim that 3D mammography is better at finding cancer has gone unquestioned in the news coverage—and not for the first time. Currently, there is no evidence that 3D mammography (also called tomosynthesis mammographic imaging) is better than 2D mammography when it comes to keeping women from dying of breast cancer. The U.S. National Cancer Institute is supporting a study, called TMIST, that aims to find out. Launched in July 2017, the randomized trial comparing 2D to 3D mammography intends to enroll about 165,000 women by the end of 2020. Results are expected around 2025. The goal isn’t to see which type of mammography detects more tumors – because detecting more tumors doesn’t necessarily translate to better outcomes for women. Rather, it’s to determine which technology is better at preventing women from being diagnosed with metastatic breast cancer. The researchers also want to see which technology has a lower rate of the false-positive results that lead to women coming back for unnecessary follow-up procedures.
Mammography remains the best breast cancer screening tool available. But it’s far from perfect. These new mammography machines are being introduced at a time when expert guidelines offer conflicting recommendations (and when mammography rates overall are declining). The American Congress of Obstetricians and Gynecologists advises women age 40 and over receive annual mammograms. The U.S. Preventive Services Task Force recommends biennial screening for women ages 50 to 74, and suggests women ages 40 to 49 discuss the benefits and risks of biennial screening with their doctors. The American Cancer Society suggests annual screening for women 45 to 54 and then the option to switch to every two years at 55. The differing guidelines and the suggestion that women talk to their doctors about what’s best for them could lead some to decide to get screened less frequently or to wait until age 50 to start screening—not because of the pain, but because of a deeper understanding of the risk to benefit ratio.
And what about the PR push by hospitals claiming that pain is the primary reason women don’t get mammograms? The data used to support this notion in Hologic’s marketing materials come from studies done by or for Hologic. GE cites a study published in 2013 in the Open Access journal The Breast that reported “painful exams explain why 25 to 46 percent of women failed to return for further breast imaging.” But of the 20 studies included in this research review, only five had data on actual re-attendance, and three included fewer than 100 women. The most recent study, and the only one done in the U.S., was reported in 2010. It included about 3300 women. The proportion that cited pain as a reason for not coming back: 12 percent.
According to the American Cancer Society, in 2015, 50% of women age 40 and older reported having a mammogram within the past year, and 64% reported having one within the past two years. This study, as have others, found the biggest factor in who gets mammograms and who doesn’t wasn’t pain: it was lack of health insurance.
Anne Marie Ciccarella, a breast cancer research advocate, thinks the focus on comfort is a distraction from the issues that really matter when it comes to breast cancer screening. “Pandering to women with the promise of warm robes and a ‘full sensory experience’ to entice patients feels somewhat demeaning and absolutely self-serving on the part of the facilities promoting these so-called suites,” said Ciccarella. “We know that early detection doesn’t guarantee survival nor does it protect us from overtreatment of seemingly harmless changes in the breast. In this era of precision medicine, I’ll take better answers [to questions about how often women should be screened] over a warm robe, a sound machine and scented oils any day.”