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Should younger women have mammograms?

Rating

3 Star

Should younger women have mammograms?

Our Review Summary

The story engages in a bit of test mongering by profiling one woman’s unusual diagnosis.  But as the story goes on to point out, screening for breast cancer in younger women (30-early 40s) at average risk of developing breast cancer may not always be a good thing. The story includes the quote about not "confusing emotions with science", but does just that by creating anxiety in the reader with anecdotal evidence, and noting that "rosy statistics" cannot be trusted. There is some balance to the story with the addition of Susan Love’s comments that screening may not benefit most younger women.

The story does not directly address the availability of newer and additional screening tools, such as MRI and ultrasound, which may be more useful for younger women with denser breast tissue. Also, the story does note some harms of screening, but neglects to mention the emotional cost of screening for younger women who may have more false-positive or benign abnormalties that do not require treatment. Increased anxiety from false-positive mammograms may affect a women’s psychological well-being regarding anxiety about breast cancer, as well as her behavior around subsequent screenings.

Overall, this was an interesting piece addressing a concern that many women in their 30s may have: whether to begin having screening mammograms for breast cancer.  Although the anecdote was alarming, many women do know of such stories.  The writer uses this personal experience to highlight her own motivation around finding evidence for screening in younger women.  She does an excellent job seeking risk information from NCI, and putting forth the best available evidence.  She also touches on the issue of false positives, since many women may subscribe to the "better safe than sorry" mentality, without considering the consequences of unnecessary testing.  The story would have been stronger if it detailed the current recommendations (or lack of them) for screening women in their 20s and 30s, and also if it included at least a brief discussion of screening for higher risk women in this age range. 

Criteria

Does the story adequately discuss the costs of the intervention?

Not Satisfactory

The story does not address the cost of annual mammography. The financial costs probably vary widely in different parts of the country (because radiologists fees vary as well as the hospital or facility fee).  Some women may wonder if they can get one and pay out of pocket even if their provider will not refer them. The story notes that screening in younger women may result in more false-positives, which increases the cost and time required for follow-up screenings and biopsies for abnormal results. False positives may also increase unnecessary breast cancer surgeries and other treatments. The story does not mention the emotional cost of screening for younger women who may have more false-positive or benign abnormalties: Increased anxiety from false-positive mammograms may affect a woman’s psychological well-being regarding anxiety about breast cancer, as well as her behavior around subsequent screenings.

Does the story adequately quantify the benefits of the treatment/test/product/procedure?

Satisfactory

The story does reference the benefits of screening for women in their 40s and after age 50 and discusses some benefit of a clinical breast exam, that is, so a woman can get a sense of changes in her breast tissue– which may prompt further imaging tests.  The story also references a recent Obstetrics and Gynecology editorial which further discusses the pros and cons of breast cancer screening for women in their 40s and younger.  

Does the story adequately explain/quantify the harms of the intervention?

Satisfactory

The story did address the most important harm of mammogram, which is unnecessary testing in the setting of false postives, which may mean further invasive testing, such as a biopsy and overtreatment with surgery. The story does not mention that mammograms sometimes also give “false negatives,” meaning that they miss cancer that is there, which may put a woman at risk of later detection which may reduce her options for surgery and may increase her risk of dying from metastatic breast cancer. 

Does the story seem to grasp the quality of the evidence?

Not Satisfactory

The story does provide recent relative risk reduction for mortality with annual mammography for average risk women after age 50, and for some women in their 40s.  The story does not provide absolute risk reduction numbers for these groups, which is important.  Based on a recently meta-analysis of many screening trials of average-risk women, for every 2000 women who had an annual mammogram for 10 years, it is estimated that one woman will have her life prolonged. Also, Dr. Love says that a 37-year-old women’s chance of being diagnosed with breast cancer is "one in a million"; according to recent SEER data about 4 women out of 1000 are diagnosed with breast cancer in their 30s.

Does the story commit disease-mongering?

Satisfactory

We’ll grade this criterion as satisfactory, although the story engages in a bit of test mongering by profiling an unusual case as an example.  Balance is provided by Susan Love’s comments that screening may not benefit most younger women. 

Does the story use independent sources and identify conflicts of interest?

Satisfactory

The story interviews a patient who provides anecdotal evidence of her experience with breast cancer at a relatively young age. The story provides the National Cancer Institute website’s risk tool and cites Robert Smith of the American Cancer Society, an organization that advocates for yearly mammograms for women in their 40s. The story also interviews a breast cancer researcher and identifies her affiliation.  This researcher provides some balance to the story, which still gives mixed messages about the pros and cons of screening. This researcher cautions that women "shouldn’t confuse emotions with science", yet the story focuses on one woman’s experience of a surprising breast cancer diagnosis in her 30s as a caution that you can’t trust screening guidelines for women at average risk, nor can you trust "rosy statistics". 

Does the story compare the new approach with existing alternatives?

Not Satisfactory

The story focuses on the benefit of mammography, but fails to mention other screening methods now used for women at higher risk, and for younger with with denser breast tissue.

Does the story establish the availability of the treatment/test/product/procedure?

Not Satisfactory

The story does not directly address the availability of mammography for women in their 40s and younger; however, the bigger issue is a lack of discussion about availability of newer and additional screening tools, such as MRI and ultrasound, which may be more useful for younger women with denser breast tissue.

Does the story establish the true novelty of the approach?

Satisfactory

The story presents the idea that screening for breast cancer in younger women (30-early 40s) may not always be a good thing. The story presents a risk calculator to help women at average risk of developing breast cancer decide if screening is appropriate; however, the story dismisses any evidence-based tools and data on age-related risk reduction by reminding the reader that statistical predictions of risk did not help the author’s friend who was diagnosed at age 37 via screening mammography.

Does the story appear to rely solely or largely on a news release?

Satisfactory

There is independent reporting and information in this story does not appear to be taken from a press release.

Total Score: 6 of 10 Satisfactory

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