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Mammogram Rate Declining, Study Suggests

Rating

2 Star

Mammogram Rate Declining, Study Suggests

Our Review Summary

The story focuses on the documented decrease in use of mammography, which is portrayed here as a negative. The anchor and her guest, a breast cancer surgeon, speculate why fewer women have been getting mammograms; they attribute this trend, in part, to legal issues closing mammography centers.  They also speculate that if women aren’t getting their HRT prescriptions, they aren’t getting their mammogram, for which there is little evidence.

 The decrease is described as "shocking" and "frightening" (and by implication, those who are not screened are at risk of dying), and there is no acknowledgement that not being screened may be a reasoned response by informed consumers. By using such terms, the broadcast is fear-mongering. It is not "shocking" that some women, especially lower-risk women age 40-49, would forego an annual mammography in light of recent evidence that the value of mammography is questionable in this group, and for women who have other medical conditions that might shorten their lives.

The story begins with the statement, "Women over the age of 40 are supposed to have one every year." But a major medical group, the American College of Physicians (ACP), published new clinical guidelines on mammography in the 40s just a month before this story, and those guidelines do not agree with the story’s opening statement.  The ACP guidelines were never mentioned in the story.

 Although most agree mammography saves lives among women aged 50 to 69, mammography also has the potential to cause these women harm. 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 the harms of mammography, journalists should explain the potential benefits and harms, and thus help women to evaluate their own individual preferences so that they can choose the course of action that best suits them.

A secondary focus of the story is the "feel good" elements of planning a mammogram around a day of shopping or a spa date. “Pampering yourself” might help some women overcome the fear of scheduling a mammogram, but this does not factor into their decision about whether or not to be screened for breast cancer, and broadcast news organizations do a disservice to their female viewers by placing health screenings in this context.

Criteria

Does the story adequately discuss the costs of the intervention?

Satisfactory

The broadcast does not provide the cost of mammography, but does address health insurance coverage and notes that a lack of insurance may be a deterrent in women’s choice to have an annual mammography.

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

Not Satisfactory

The reporter does cite data, but just relative not absolute (see our primer), and probably paints a rosier picture than reality, especially for women in their 40s. Individuals studies vary widely but there are lots of problems with the studies. Average is about 20-30% reduction in mortality.

The story focuses on the "feel good" elements of planning a mammogram around a day of shopping instead of providing useful data-driven health information to the viewer.

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

Not Satisfactory

The story doesn’t mention any potential harms of mammography. This is a major flaw, as it was in an January 26th ABC broadcast on this topic.  We repeat what we wrote then: "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 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). 

 The story begins with the statement, "Women over the age of 40 are supposed to have one every year." But at least one major medical group, the American College of Physicians (ACP), published new clinical guidelines on mammography in the 40s just a month before this story, and those guidelines do not agree with the story’s opening statement.  The ACP guidelines were never mentioned in the story. 

Does the story commit disease-mongering?

Not Satisfactory

The broadcast does provide accurate American Cancer Society estimates for annual deaths from breast cancer, but "2 million women who survived breast cancer" cannot be attributed solely to screening. Early detection and treatment have together have been shown to improve survival.

By using terms like "shocking!’ and "troubling", the broadcast is fear mongering. It is not "shocking" that some women, especially lower-risk women age 40-49, would forego annual mammography in light of recent evidence the value of mammography is questionable in this group and in women 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.

The story begins with the statement, "Women over the age of 40 are supposed to have one every year." But at least one major medical group, the American College of Physicians (ACP), published new clinical guidelines on mammography in the 40s just a month before this story, and those guidelines do not agree with the story’s opening statement.  The ACP guidelines were never mentioned in the story. 

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

Not Satisfactory

We are only given one point of view, that of a breast cancer specialist who encourages all women over 40 to be screened. She does not discuss the downside of this screening.  Balance and additional sources are needed.

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.  Also, the broadcast does not mention the rate of false positives with mammography, which may increase the number of breast biopsies and unnecessary breast cancer treatments.

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

Not Satisfactory

The broadcast explains that the number of U.S. women receiving annual mammograms has decreased in recent years. The segment only offers speculation on why this is, but provides no sources. A GAO report found that, despite facility closings, “current capacity is adequate.”  

Does the story establish the true novelty of the approach?

Satisfactory

Mammography is not new.  The broadcast reports a new study reporting a decline in mammography screening and speculates on the causes.

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

Satisfactory

Information in this broadcast does not appear to be taken directly from a press release.

Total Score: 3 of 10 Satisfactory

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