The story focuses on results of a Swedish large study that showed a survival benefit from annual breast cancer screening for women in their 40s. This story also briefly reviews a recent study reported at the same conference, however, dealing with survival from breast cancer. Simply put, these are two separate issues (screening and survival) and it is very confusing to put the results and comments together in the same piece.
Perhaps largely because the story doesn’t adequately evaluate the quality of the evidence of the new Swedish study, it has an unbalanced feel of promoting annual mammograms based on this recenty published data and via the selection of experts cited. The downsides of screening for women 40-49 are not discussed at all.
While this story begins telling readers that "Another study…finds that screening can lower the risk of dying…" – look at how other competing stories began:
No such skepticism, no such independent critical evaluation took place in the HealthDay story.
Women – especially in their 40s – must be terribly confused by the swirling studies. The US Preventive Services Task Force recommendations last November, the American Cancer Society and others’ backlash against it, the Norwegian study in the New England Journal of Medicine, and now the new Swedish study. This is when journalism must rise to the challenge with an extraordinary effort to help evaluate evidence, ask tough questions, and offer insightful analysis. That just didn’t happen with this story. It was more like stenography from a teleconference. Disappointing.
The story does not discuss the costs of annual mammography screening, or even provide a range of costs. The story does not discuss any health care policy cost repercussions of breast cancer screening recommendations. The story does not discuss the cost of unnecessary biopsies or other treatments for women who have a false positive diagnosis via mammography (greater in women 40-49).
The story does note the benefit of screening at age 40-44, 44-49 and for women 50 and older; however, only the relative benefit was given. The story should have reported the number of women in the cohort, who was screened, how long they were followed, and the absolute reduction in breast cancer mortality observed. That has been our standard all along on this site and this is no time to change.
The story does a poor job discussing any harms of screening women starting at age 40. We are not told if women 40-44 had more false positive and unncessary biopsies ,or unncessary breast cancer surgery or treatments for pre-cancerious lesions. We are also not told of the risks of additional radiation exposure on the risk future of breast cancers. We are not given the number needed to harm (NNH) for additional radiation exposure over 10 years of screening.
The story tries to summarize the study and to put results in context with other recently published data. But we really expect more of an evaluation of the quality of the evidence than to just quote one of the authors saying he "could not pinpoint exactly why his findings differed from those of other studies" and that "he mentioned certain differences in methodology as a possible factor." What? That’s the end of the discussion? These are huge questions. There are many important methodological issues that could/should have been addressed and that WERE addressed by competitors’ stories (see our reviews of the AP, LA Times and NY Times stories.) There are many, many experts who could have been interviewed about research design who could have shed light on these concerns – and some of them were interviewed by competitors. Especially given the back and forth of competing studies (Norway last week, Sweden this week), readers need much more help navigating the evidence. This story just fell short of the mark.
The story does provide the NNT (number needed to treat) to place mortality risk in context here: i.e. screening 1,250 women five times over a 10-year period would save one life.
The story cites independent sources, including the Swedish study author and chair of the American Society of Clinical Oncology’s communications committee, as well as other breast cancer researchers who found a benefit in screening younger women and a decline in breast cancer mortality. However, these sources do not discuss the downsides of treatment. No one is cited to discuss the downsides of mass screening in a group where the risks may outweigh the benefits. Risks of screening low to average risk women in their early 40s include: overtreatment, false positive biopsies, anxiety, and in some cases, a fear and avoidance of future screening when mammography may be of greater benefit. Why not interview a member of the USPSTF to discuss their reaction to this recently published data? The USPSTF guidelines also do note that women at low-average risk discuss screening with their doctor. There is no mandate that women 40-49 not have access to annual screening.
Quotes from both Dr. Jennifer Obel of ASCO and from study co-author Hakan Jonsson apparently came from an ASCO teleconference. There was no evidence of any independent research to find independent experts to comment on the study.
The story does not discuss the option of NOT screening. It does quote Dr. Jennifer obel saying "While the optimal schedule of regular mammograms continues to be discussed by experts in the field, the critical message here is that all women starting at age 40 should talk to their doctor to understand the benefits and risks of screening and to understand what is best." But the story had already framed the new study as counter to the US Preventive Services Task Force recommendations last November – yet this quote is almost the same thing that USPSTF recommended last Fall.
ONLY because the story at least cited the USPSTF’s concerns aboutr screening in the 40s, we will give it a barely satisfactory score, because that at least implies there’s an option of foregoing screening. But we easily could have gone the other way with this criterion score as well.
The story does not discuss availability of mammography, but such availability is really not in question. So this is judged not applicable because we can’t give it a satisfactory or an unsatisfactory score.
The story just didn’t capture what was new and different and noteworthy about the way in which this research was done. Someone who’s not a journalist, Dr. Len Lichtenfeld of the American Cancer Society, still captured the "novelty" of the research succintly on his blog. He began his explanation, "There is a bit of a twist in the study which is important to understand." Indeed, you can read more about what’s important to understand and why on Dr. Len’s blog, because it wasn’t provided in this story. The answer gets at the heart of the methodology used – and whether it renders the research strong or questionable.
The story does not appear to rely on a news release. However, it does appear to rely entirely on what was presented in a teleconference sponsored by the conference host organization. In the end, is that any different that relying on a news release? Was their any independent vetting of claims that took place? There’s no evidence of that. We’ll rule this not applicable.