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Fewer mammograms being done, studies show

Rating

4 Star

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Fewer mammograms being done, studies show

Our Review Summary

We give the story credit for highlighting the main point — that the benefit is small and that women should be informed and given a choice. The piece could have ended with that. it also would have been good to comment more on the science of the studies which were not really particulary powerful or well designed to support the claims (e.g. they don’t advance the science that mammograms save lives) or generalize well to the provider population at large.

 

Why This Matters

Demonstrating far more balance than some other stories, this report allowed the chair of the US Preventive Services Task Force to explain their recommendations:

  • “The task force did not say don’t get mammograms, Moyer said. “It might make women not want to get the test,” she said. “This is a decision that should belong to the woman with appropriate info on hand.”

But still missing in the piece was any recognition of the possibility that a decline in mammography in women in their 40s could be a good thing.

Criteria

Does the story adequately discuss the costs of the intervention?

Not Satisfactory

At some point, costs must enter into this discussion.  But this story never got there.

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

Satisfactory

The story states:

“The data that we have suggests that 1 in a thousand will benefit from mammograms in the 40-49 age,” (the USPSTF chair) said. “There are whole lots of assumptions that are not supported by the data they presented.”

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

Satisfactory

We wouid have like to have seen more discussion of the potential harms in 85% of biopsies being non-cancerous.  But since the story did actually quantify the number of false positives, we’ll give it the benefit of the doubt on this criterion.

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

Not Satisfactory

Better than the competing Denver Post story if only because CNN allows the US Preventive Services Task Force chair to explain their recommendations – something the Denver story didn’t do.

But there could have been more scrutiny of the studies reported on. There was not much focus on whether we can really learn much from the single site retrospective study of their biopsies (did they compare to biopsies from patients who did not have screening mammograms? on what basis were they claiming that they were more treatable? and that being more treatable leads to longer life?).

Does the story commit disease-mongering?

Satisfactory

No overt disease-mongering.

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

Satisfactory

Good sourcing, including – unlike the competing Denver Post story – input from the chair of the US Preventive Services Task Force.

Does the story compare the new approach with existing alternatives?

Satisfactory

There was a far more balanced discussion of harms and benefits in this story, although the use of personal opinion and recommendations, and the ending resulted in an imbalance in the piece.  Excerpts that demonstrate this imbalance:

  • “I haven’t met many patients who don’t appreciate us being thorough, to trying to find the cancers at an early stage,” Plecha said. “I would still recommend screening mammograms starting at age of 40,” because cancers caught earlier would be more curable.
  • (story ending:) Although the task force concluded that the net benefit of mammography in the 40s is small, Hardesty said: “If you’re the one person we find your cancer, it’s the world to you.”

Wouldn’t a more balanced way to end the piece – focusing on the shared decision-making element so important in this issue – have been to end with this:

  • The task force did not say don’t get mammograms, Moyer said. “It might make women not want to get the test,” she said. “This is a decision that should belong to the woman with appropriate info on hand.”

Nonethless, all of this was in the piece, so we’ll give it the benefit of the doubt.

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

Adequate job putting the new studies in context of past research and recommendations.

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

Satisfactory

It’s clear the story didn’t rely solely on a news release.

Total Score: 7 of 9 Satisfactory

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