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Fewer mammograms means more breast cancer deaths

Rating

2 Star

Fewer mammograms means more breast cancer deaths

Our Review Summary

This broadcast describes data from two recent government reports showing that fewer women are undergoing mammograms and fewer mammography centers are in business today than a few years ago. It quotes one expert who says this means that more women will therefore die of breast cancer. Few would argue that all women should have access to mammography. However, the broadcast provides no evidence to support the dire conclusion of the expert that more deaths will ensue. It also fails to balance this view with information about the potential harms of mammography. And it neglects to note that the GAO report says that current capacity is “likely adequate.”  What is the quality of evidence on this complex topic? There is no way to tell from the broadcast whether the scientific evidence supports the view that fewer mammograms will categorically result in more cancer deaths, nor any attempt to weigh this against the evidence that mammography may produce harms as well as benefits.  Most experts believe that mammography in women aged 50 to 69 saves lives; its benefit in those younger and older is controversial. But like other cancer screens, improved survival among women who undergo mammography may be deceiving. It is possible, for example, that screened patients do not actually live longer than unscreened patients do, but simply appear to live longer because they receive a diagnosis earlier.  It is also possible that mammography will actually cause harm. Exposure to radiation during mammography could itself cause breast cancer 10 or 20 years down the road. (Br J Cancer 2005;93:590-6. Lancet 2000;355:1757-70) In addition, mammograms increase the diagnosis of lesions. Left untreated, some of these will become cancers, but many will not. The discovery of a lesion leads not only to fear and anxiety, but also to invasive diagnostic tests and invasive treatments (including mastectomy or lumpectomy) that inflict additional emotional and physical harm. “For every woman who has her life extended by screening,” writes the Cochrane Center’s Peter Gotzsche in Denmark, “there are at least five women who will be diagnosed with, and treated for, cancer unnecessarily.” (Lancet 2005;366;1519-20) One learns nothing about these potential harms in the ABC News broadcast.  Because medicine does not yet have perfect estimates of the harms of mammography, some would say there is no simple “right” recommendation for every patient. The only possible blanket recommendation might be for clinicians–and the news media–to explain the potential benefits and harms, and thus help women to evaluate their own individual tolerance for risk and preferences so that they can choose the course of action that best suits them.  News organizations that choose to cover medicine should explain the quality of the evidence and the pros and cons surrounding any medical procedure well enough for patients to understand what is known and what remains unknown. Unfortunately, instead of an even-handed analysis, this broadcast promotes fear.

Criteria

Does the story adequately discuss the costs of the intervention?

Not Satisfactory

The news story makes no mention of cost. Although the cost of mammography to individuals is generally not great, the financial burden on the health care system is substantial.

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

Not Satisfactory

The story describes the reduction in mammograms and mammography centers in both relative and absolute numbers. But there is no quantification of the estimated benefit of mammography itself.  That benefit is just assumed, leading to a concurrent assumption about the impact of fewer mammography centers. 

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

Not Satisfactory

There is no mention of harms. This is a major flaw. Although mammograms can identify disease early and reduce deaths, they are also associated with several harms. Mammograms increase the diagnosis of lesions. Left untreated, some of these will become cancers, but many will not. The discovery of lesions leads not only to fear and anxiety, but also to invasive diagnostic tests and invasive treatments (including mastectomy or lumpectomy). Finally, mammography exposes women to radiation that could itself cause breast cancer 10 or 20 years down the road. (Br J Cancer 2005;93:590-6. Lancet 2000;355:1757-70). Because medicine does not yet have perfect estimates of these harms, the decision to have mammography is not always simple.

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

Not Satisfactory

The news broadcast demonstrates no grasp of the evidence around this controversial area of preventive medicine. There is no mention of the quality of evidence to support the fear that fewer mammograms will categorically result in more cancer deaths, nor any attempt to weigh this evidence against the evidence that mammography may produce harms as well as benefits. (See “Harms of Treatment” below)

Does the story commit disease-mongering?

Not Satisfactory

The news story quotes one expert who asserts that less screening will mean more cancer deaths. But when? Today or next year? The GAO report says that current capacity is “likely adequate,” adding that the entry of fewer health care professionals into the field “could result in access problems in the future.” (http://www.gao.gov/new.items/d06724.pdf) The CDC report says “Because mammography screening every 1–2 years can significantly reduce mortality from breast cancer, continued declines in mammography use might result in increased breast cancer mortality rates.” (http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5603a1.htm.) The broadcast also ignores evidence that questions the value of mammography in women aged 40-49 and over age 70 who have other medical conditions that might shorten their lives. Finally, the news story overlooks the flip side of screening. Although most agree it saves lives among women aged 50 to 69, mammography also has the potential to cause these women harm. (See “Harms of treatment” below.) Viewers would be better -served by an even-handed explanation of the potential benefits and risks of having a mammogram, so that women could make an informed decision. Instead, the broadcast spreads fear.

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

Satisfactory

Two independent sources were quoted.  The broadcast cites data from the CDC and the GAO, independent government agencies. 

Does the story compare the new approach with existing alternatives?

Not Satisfactory

The broadcast provides no information about other alternatives to mammography, which for some might include doing nothing.

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

Not Satisfactory

The broadcast explains that the number of mammography centers and mammograms in the U.S has decreased in recent years, and cites reliable sources for this. But it does not report the GAO’s finding that, despite facility closings, “current capacity is adequate.”  

Does the story establish the true novelty of the approach?

Satisfactory

The news broadcast explains that screening goes back at least to 1987; a viewer who might be unfamiliar with the procedure can accurately glean that it is not new.

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

Satisfactory

No obvious use of text from the press release.

Total Score: 3 of 10 Satisfactory

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