This story does a fairly good job carefully walking readers through a new study on a highly charged topic: the benefits of mammography. It pulls together a range of voices from different perspectives but allows one voice, that of the pro-mammography radiology community, to dominate the others. Given how thorough the story is in reviewing the science behind the new findings, it should also have talked about the costs associated with mammography, the harms associated with unnecessary procedures, and the variety of screening protocols and treatments available – including foregoing screening.
We are in a bit of a mammography moment right now. Clinicians and policymakers are talking about the risks, benefits and costs, and, literally, lives could be saved or lost based on the outcome of these discussions. More than ever, patients need clear information to help them decide how to make decisions about their own health that may end up being in conflict with their doctor’s advice, depending on where their doctor stands in this debate. Stories like can help bring clarity to the discussion by taking pains to stick to the science and avoid "muddying the waters" with emotion or financial considerations.
This is a big one to miss. Mammograms usually are covered by insurance, but because of the conflicting guidelines, there is a concern that some insurance companies won’t want to cover mammograms for women under 50. Also, if a woman doesn’t have insurance and falls into the right demographic, they will need to foot the bill. It would not have been difficult to find out how much they cost and even to find someone to estimate how much is spent every year in the U.S. on mammograms.
Right off the bat, the story says, "Routine mammograms account for only about one-third of the decline in breast cancer death rates, according to a large new analysis of data from Norway’s expansive breast cancer screening program." It takes too long, we think, for the story to follow this up with more data. Instead, we are given this dubious statistic from an oft-quoted member of the American College of Radiology. He says that "since the advent of routine mammograms in the 1990s, the rate of death from breast cancer has dropped 30 percent." Ask an oncologist about what has happened to cancer care since the 1990s, and you may get a different answer as to why that death rate has dropped.
In the fourth graph, we are given this great quote from the lead author, Dr. Mette Kalager, an epidemiologist with the Cancer Registry of Norway in Oslo and a visiting scientist at the Harvard School of Public Health in Boston. "Women should be informed that the benefit is smaller than expected, and there should be a balanced discussion on the benefit and the possible harms of screening, such as overdiagnosis, false-negative and -positive tests and psychological distress." Given how thorough the story was in other areas, we hoped to see some of these potential harms actually broken down later in the story. What has research shown to be the estimated amount of overdiagnosis, false-negatives and false-positives? Some of these numbers would have been a nice counterpoint to some of the statements elsewhere in the story touting the benefits of mammograms.
There is no disease mongering in this story.
The story could have done a better job explaining that self-exams are also another common, although also controversial, means of detecting breast cancer and that gene testing has given rise to a subgroup of patients with the BRCA1 and BRCA2 gene mutations who have opted for aggressive prevention measures, such as complete breast removal. Cancer is a complicated disease, and some of this could have been captured, even in the limited space.
Even more broadly, it never explicity addressed the option of foregoing mammography in any detail – which is hard to overlook in this case.
The availability of mammograms is clear from the story.
The story makes it clear that, far from novel, mammography is a frequently used screening procedure that is coming under new scrutiny because of mounting evidence that it does not produce the benefits early research showed.
The story did not rely on a news release.