This television segment about breast self-exam recommendations confuses and misleads viewers about an important public health issue. Significant flaws include the following:
- There is a distinction between the benefits of breast awareness (which can lead to identification of some clinically significant irregularities), and the regimented monthly self-exams often recommended by breast cancer experts (which the Cochrane research concludes appear to cause more harm than good).
- Every woman has a different risk profile for breast cancer. Individual recommendations for breast self-exam, clinical exam, mammography and other screening and diagnositic techniques will vary with these profiles.
The anchor at one point says he has to "speak up for all the people yelling at their televisions." People who understand the points above may indeed yell at their TVs, but for reasons the news staff may not appreciate.
It doesn’t cost anything to do a breast self-exam.
But the story fails to mention the related costs of unnecessary diagnostic procedures triggered by self-exams.
The reporter hints at the costs associated with public health campaigns that educate women to perform self-exams but fails to make this point clearly or to specify costs.
The segment does report that no evidence proves breast self-exam beneficial.
While the broadcast segment does provide some detail about the two international studies upon which the Cochrane report is based, it fails to explain the basis for these counterintuitive conclusions–self-exams led to more biopsies but had no effect on death.
A report by HealthDay summarizes the research findings cleanly: "There is no evidence that the practice actually decreases deaths from breast cancer while it may actually double the number of unnecessary biopsies in women who do the exam compared with women who don’t."
A report by the Center for the Advancement of Health, a non-profit foundation, is similarly clear about the findings.
The key recommendation against breast self exams is a lack of demonstrated benefit. But this story fails to raise the other important side of the harms/benefits equation: The fact that discoveries of lumps by women themselves can trigger unnecessary, expensive and stressful diagnostic procedures.
This leads to an incorrect statement: that a self-exam is "not harmful. . .it just doesn’t do any good."
The failure to explain the harms that can follow self-exam is an extraordinary journalistic failure.
The story states, "There’s word tonight that yet another health organization will recommend against advising women to carry out regular breast self-examinations." But we never hear who that organization is or how they came to that conclusion. The story is based on an update of a report by the Cochrane Collaboration, a credible international group that analyzes bodies of scientific literature to determine overall findings (although this is never mentioned in the story).
The underlying research consists of two large international trials whose findings the researchers conclude do nothing to unsettle the conclusions of its most recent meta-analysis.
The segment does not exaggerate the gravity or frequency of breast cancer.
The segment is based on an update of a report by the Cochrane Collaboration, a credible international group that analyzes bodies of scientific literature to determine overall findings.
Yet the segment fails to mention the source of this report. The anchor simply says "yet another health organization will recommend against advising women to carry out regular breast self-examinations."
Failing to state the source is a peculiar choice, given the counterintuitive, controversial nature of the recommendation.
The segment mentions mammograms as a diagnostic option. Yet it states, "There is no question, experts say, that regular mammograms save lives."
While it is true that some experts say this, others disagree. The question of whether screening mammograms lower death rates is a controversial and highly politicized area of research.
Last year the Annals of Internal Medicine published a careful clinical practice guideline based on the latest research. It identifies certain subgroups of women for whom regular mammograms have been shown to significantly decrease breast cancer mortality. But it falls far short of claiming that "regular mammograms save lives."
The "availability" of breast self-exams is implicit, and need not be reported here.
Breast self-exam is not novel; neither are the recommendations being discussed. And the story explains that major studies have been questioning the value of breast self-exams for more than 10 years.
We can’t be sure if the story relied solely or largely on a news release.