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Fewer Colorado women getting mammograms since 2009 guideline change

Rating

2 Star

Fewer Colorado women getting mammograms since 2009 guideline change

Our Review Summary

The reason for this story is the release of new studies, but readers aren’t told where the studies are presented, where they appear, how anyone can read more about their findings. 

Inexplicably, the story includes no response from the Task Force itself.  So a clear imbalance exists in the story.

Indeed, a flip side to the story that there’s a decline in 40-year old women getting mammograms is that this is a good thing.  But the story never even hints at that possibility.  When given the choice, one of these studies suggests that most women in their 40s continue with mammograms.  The shared decision-making angle to the story is missed.

 

Why This Matters

Anecdote and emotion, intuition and strongly-held beliefs.  That’s what has so often dominated the mammography-in-the-40s debate.  This story didn’t delve into the data, and therefore, told only one side of this story. 

Criteria

Does the story adequately discuss the costs of the intervention?

Not Satisfactory

At some point, cost has to enter into this discussion.  The story stated two things related to cost: 

  • The recession and loss of work-based insurance might explain some decline
  • "Colorado advocates said they had not seen evidence that payers were trying to cut out mammograms after the study. The state legislature passed a law last year requiring Colorado insurers to pay for mammograms every year past age 40."

What is that cost?  To the insured?  To the uninsured?  How many women did lose insurance coverage in the time frame in question?

 

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

Not Satisfactory

The story focused on the alleged harms of the USPSTF mammography guidelines.

Any benefits attributed to earlier screening weren’t quantified, and were stated hypothetically.  And in so doing, the story overstated the evidence regarding benefits for the studies covered in the piece, particularly the Ohio study, without any quantification.

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

Not Satisfactory

The story didn’t quantify any harms – not those outlined by the USPSTF, nor those hypothesized by the new research reported.

It included this quote:  "I think this has caused more damage than good," said Michele Ostrander, executive director of the Denver branch of Susan G. Komen for the Cure.  But it didn’t quantify what that damage has been.

You could also look at these findings from this perspective: that a 15% reduction may be appropriate; most women still got their mammogams and likely still will – so the "damage" by letting women make their own decisions doesn’t seem huge.

 

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

Not Satisfactory

There was no apparent attempt at balanced consideration of the evidence.  Indeed the story reported no data from the "Ohio study to be released today showing mammograms lead to earlier cancer detection for that age group."

And it ontained no quote, no explanation, no reaction from the US Preventive Services Task Force – only criticism thereof.  HealthDay, by comparison, in a related story, quoted the USPSTF chair: 

Dr. Virginia Moyer, current chair of the USPSTF, said the public often misreads the panel’s controversial 2009 guidelines, thinking no one 40 to 49 should have a mammogram.

"This is not what the recommendation says," she stated. "It says that the decision should be individualized, taking patient context into account, including the patient’s values regarding benefits and harms."

Moyer said it is known that, on average, mammogram screening results in some benefit. But, "for women in the 40- to 49-year-old age group, this benefit appears to be quite small, and has to be balanced against the known risks, which are greater in younger than in older women," she said. Among those potential risks are false-positive results, and the undue anxiety and unnecessary biopsies that can result, Moyer noted.

 And in another story we reviewed, CNN.com turned to Dr. Moyer high in the story for the Task Force’s perspective on these studies.

Does the story commit disease-mongering?

Satisfactory

No overt disease mongering.

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

Not Satisfactory

There were several sources interviewed but they all stack up on one side of the debate.

How can you report a story criticizing the US Preventive Services Task Force and NOT interview anyone from the task force for a reply?

Other news sources – such as CNN.com (whom we also reviewed) and Health Day – turned to the Task Force for comment.

Does the story compare the new approach with existing alternatives?

Not Satisfactory

There was not a sufficiently detailed, data-driven comparison of screening versus not screening in the 40-49 age group.

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

Not Applicable

Not applicable.  The availability of mammograms is not in question.

Does the story establish the true novelty of the approach?

Satisfactory

The story made it clear that this was a new analysis of mammography utilization patterns.

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

Satisfactory

Since several sources were interviewed, it doesn’t appear that the story relied solely on a news release.

Total Score: 3 of 9 Satisfactory

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