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Mammograms Less Effective Than Believed

Rating

5 Star

Mammograms Less Effective Than Believed

Our Review Summary

This story did a nice job of presenting the methods and results of a Norwegian study that calls into question the benefits of routine mammography. In addition to discussing the harms associated with routine mammograms and providing quotes from individuals on both sides of the debate, the story was careful to highlight the important fact that a woman can decide to have routine mammograms or they can decide to forego them, depending on how they feel about the risks and benefits. A significant oversight, however, was not discussing the cost; particularly given the concern many people have regarding how these findings may affect insurance coverage.

 

Why This Matters

This is a very important piece of research as it concerns one of the major causes of cancer death among women and mammography is the only commonly used population screening test for breast cancer. Given this, it is a very hotly debated topic, and the story includes a quote from Dr. Gilbert Welch that sums up the issue nicely: “It is not wrong to want a routine mammogram, and it is not wrong not to want one.”

Criteria

Does the story adequately discuss the costs of the intervention?

Not Satisfactory

This story did not mention the cost or insurance coverage for mammograms – an unfortunate oversight given the nature of this story.  

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

Satisfactory
The story reports the results in relative terms, but it also quotes Dr. Gilbert Welch, who wrote the accompanying editorial in the New England Journal of Medicine, in presenting the Number Needed to Treat (NNT) to explain the results. In this case, 2,500 women will need to be screened to prevent 1 death from breast cancer.   

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

Satisfactory
This story clearly explained that there are harms associated with mammograms, specifically the stress and anxiety caused by false positive results and the adverse effects that can results from unnecessary treatment of cancers that may not cause problems. Furthermore, the story quantified the number of women who will receive needless treatment based on mammography findings.

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

Satisfactory
Overall, the story did a very nice job describing the study methods and specifically mentioned that it was not a randomized clinical trial. However, it would have been helpful had the story provided the incidence rates in the screening and unscreening groups. Absolute rates are necessary for comparison with other countries that may have different racial or ethnic distributions and breast cancer risk factors. Furthermore, the story should have mentioned the number of women included in the trial, their average age (and range of age), as well as the relatively short follow-up time. 

Does the story commit disease-mongering?

Satisfactory
The story did not exaggerate the prevalence or seriousness of breast cancer.

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

Satisfactory
The story includes quotes from individuals not affiliated with the research, including Dr. Welch and a spokesperson for the American Cancer Society. These differing viewpoints provide needed perspective to the story.

Does the story compare the new approach with existing alternatives?

Satisfactory
This story clearly states that women may choose not to have routine mammograms and also mentions becoming aware of breast symptoms, presumably through self-exams. Although these screening methods are controversial, it would have been helpful had the story explicitly discussed breast self-exams or physical exams by a clinician.

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

Satisfactory
The availability of mammograms is not in question.  

Does the story establish the true novelty of the approach?

Satisfactory
It is clear that mammograms have been around for a long time, but the story points out that these recent findings are a departure from previous risk reduction estimates from U.S. studies.

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

Satisfactory
This piece does not rely on a press release.

Total Score: 9 of 10 Satisfactory

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