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The trouble with mammograms

Rating

5 Star

The trouble with mammograms

Our Review Summary

The idea that screening may be harmful is not often discussed in news stories.  The story nicely presents this seemingly counter-intuitive point that finding more cancer may not save lives; however, the story could have discussed the role patients can play in deciding whether or not to get screened and how they could discuss this decision with physicians, who may be strong advocates for screening. The story does not mention that women could discuss an individualized screening schedule with their physician.  Some women at higher-risk of breast cancer may be better candidates for annual screening between age 40-50 (or earlier, depending on family history or genetic markers), while others may not wish to screen until they are in their 50s or 60s.  The story does not mention how physicians could counsel anxious patients on the true value of screening for breast cancer.

The story does note that mass screening results in overtreatment and possibly unnecessary treatment for some women; however, the cost implications for such treatments are not discussed, an important omission at this time in the development of U.S. healthcare policy and physician reimbursements for screening.

The story superbly cites expert epidemiologists and clinicians who discuss the problems with overselling mammograms and how this flies in the face of public health campaigns and U.S. clinical guidelines that women over 40 get annual mammograms. The story also cites a breast cancer survivor and advocate who questions the value of screening for some women.  An advocate from a pro-screening group is also cited and her message is balanced by a clinician (who consults with the organization) who gives a tempered response to the latest data that screening may not benefit, and may even harm, women who are not at high-risk of developing aggressive breast cancer.

Criteria

Does the story adequately discuss the costs of the intervention?

Not Satisfactory

The story does note that mass screening results in overtreatment and possibly unnecessary treatment for some women; however, the story does not address the cost implications for such treatments–around $10 billion annually for screening and another $10 billion annually on treatment– an important point at this time in the development of U.S. healthcare policy and physician reimbursements for screening.

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

Satisfactory

The story does a nice job presenting the number needed to test or NNT (how many women screened regularly would save one life) and NNH (how many women screened who would receive unnecessary treatments).   These are important numbers that are typically missing in health news stories.  The story also notes other evidence that 22% of cancers might regress on their own. This is another important point that women may wish to consider as they plan a personal mammography screening schedule, or if they choose not to screen for breast cancer.

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

Satisfactory

The story describes the discomfort of mammography and the potential harms of screening, i.e. finding benign lesions and overtreatment for a less agressive cancer.  The story does not mention the anxiety many women face both before and post-screening, especially if a mammogram is positive.  The false positive rate of mammography is about 50% over 10 years (~with 10 mammograms likely to get one false positive).

 

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

Satisfactory

The story does an excellent job explaining the BMJ study design and evidence from a recent Cochrane review of breast cancer screening.  This new information is presented in the context of similar analyses that also found screening was overvalued for saving lives. 

Does the story commit disease-mongering?

Satisfactory

The story does not engage in disease mongering. Instead, the story discusses lower-risk forms of cancer and pre-cancerous lesions that may not need to be treated. 

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

Satisfactory

The story does a superb job here. There are expert epidemiologists and clinicians who discuss the problems with overselling mammograms and how this flies in the face of public health campaigns and U.S. clinical guidelines that women over 40 get annual mammograms. The story also cites a breast cancer survivor and advocate who questions the value of screening for some women.  An advocate from a pro-screening group is also cited and her message is balanced by a clinician (who consults with the organization) who gives a tempered response to the latest data that screening may not benefit, and may even harm,  women who are not at high-risk of developing aggressive breast cancer.

Does the story compare the new approach with existing alternatives?

Satisfactory

The story raises the clear option that some women may choose not to have regular mammograms – an option not often discussed in news stories.

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

Satisfactory

The long-time availability of mammograms is evident in the story. With the exception of certain lower socio-economic communities and geographic areas, mammograms are increasingly available to women as a result of well-funded public health campaigns and messages that more screening will save lives. The story focuses not on availability, but on a recently published article which adds evidence to previous meta-analyses that mammograms may be oversold for saving lives. 

 

 

Does the story establish the true novelty of the approach?

Satisfactory

The idea that screening may be harmful is new in the popular press.  The story does a nice job presenting this seemingly counter-intuitive point that finding more cancer may not save lives; however, the story could have discussed the role patients can play in deciding whether or not to get screened and the role of shared decision-making between patients and caregivers. 

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

Satisfactory

The story does not appear to rely on a press release for information. There is a good deal of interpretation of medical studies and independent reporting from a range of clinical experts and breast cancer advocacy groups.

Total Score: 9 of 10 Satisfactory

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