This story reports on a new analysis of the scientific evidence used by the United States Preventive Services Task Force (USPSTF) to make its 2009 recommendations regarding mammography screening. The authors of the analysis, published online by the American Journal of Roentgenology, arrived at different conclusions than the Task Force’s recommendations.
But the story didn’t include any sense of how the new analysis was done or why its conclusions were different. There was no analysis of whether the new analysis took a reasonable approach.
That’s what women needed in order to understand the story.
The Task Force’s 2009 recommendations generated a lot of controversy. This new analysis is the first to use the Cancer Intervention and Surveillance Modeling Network to further examine the evidence used by the USPSTF. But this story did not provide strong or compelling data to help readers evaluate or compare the quality of the two analyses. And it did not present both sides of this controversy.
The piece does not include any discussion of the financial, physical, or emotional costs of beginning routine mammography screening at age 40, which the authors of the new analysis see as necessary. The financial costs of overdiagnosis are significant for both the individual diagnosed and for society. The article does not include information about the increased number of false positives that will result from annual screening beginning at age 40 or about the significant physical and emotional costs of false positives. The article is dismissive of these harms. From the article it is not clear whether the new analysis considered any of these harms or was solely based on breast cancer mortality.
Recommendations about mammography screening beginning at age 40 have been controversial at least since the 1990s. Because of this history of controversy and women’s fear of breast cancer, the framing of a story about screening mammography is especially important. This article frames the new analysis in a totally favorable way and includes two significant inaccuracies. First, the article states that “…annual mammograms save 65,000 more women from breast cancer.” Mammograms do not prevent breast cancer. Their purpose is to detect breast cancer. Second, the article includes a misleading relative risk reduction by stating that beginning mammography at age 40 “…cuts…risk of dying from breast cancer by 71%.” The study calculated mortality reduction for annual mammograms beginning at age 40 at 39.6% versus 23.2% according to the USPSTF recommendation.
The article does not include information about the potential harms resulting from routine, annual mammography beginning at age 40. Readers, especially women who may decide to begin annual screening at age 40, need to be told about the possibility of false positives and unnecessary biopsies. Authors such as Welch and Esserman have referred to overdiagnosis and overtreatment.
The article does not adequately describe how results of the new analysis were generated or provide the reader with any way to compare how or why this model differed from the one used by the USPSTF. Explaining some of the assumptions used that led to different results would be helpful for readers.
While the article does not exaggerate the incidence of breast cancer, it does state that “annual mammograms save 65,000 more women from breast cancer.” This could lead women to believe that mammography prevents breast cancer when its purpose is to detect breast cancer. Incorrect and misleading.
The only independent source quoted in the article is the chair of the Breast Imaging Commission of the American College of Radiology. This source would be biased toward recommending more frequent screening.
The article should also have included reactions from members of the USPSTF or from groups that supported the recommendations of the Task Force.
The article does not mention that one author of the analysis is a consultant to GE Healthcare, a major manufacturer of mammography equipment. The other author of the analysis has received grant support from GE Healthcare.
The article fails to mention the disadvantages of annual mammography screening beginning at age 40. By not including balanced information, the article may lead readers to believe this new analysis is totally accurate. The choice of declining screening was not presented as a reasonable option.
Not applicable. There’s no question about the availability of mammograms.
The article does note that it is reporting on a new analysis of evidence that was also used by the USPSTF when it determined its 2009 mammography screening recommendations.
The article does not adequately explain why this new analysis arrived at different conclusions than the USPSTF. By failing to do this, the article does not provide readers with sufficient information to judge the new analysis.
The story does not rely on a news release. It includes quotes from one of the authors of the new analysis and from the chair of the American College of Radiology’s Breast Imaging Commission.