This HealthDay news story reports on findings among women diagnosed with breast cancer: those who had longer intervals between mammograms end up getting more aggressive treatments, including chemotherapy and surgery.
The story would have been stronger had it described the findings using absolute rather than relative numbers. But, we were glad to see an independent source offer some reservations about the small observational study raised. A final note — the image accompanying the story was laughably unrealistic.
Mammograms are the primary screening method for detecting breast cancer. However, when to start getting mammograms and how often to get screened have been subjects of controversy for the past decade. That’s because the data on how to balance risk of developing breast cancer and the risk of harms from screening (unnecessary tests and procedures) are interpreted differently by doctors and other experts. A story that adds new data to the field and that might tip current guidelines one way or the other is newsworthy.
The article did not discuss costs. Screening mammograms impose a significant cost on the U.S. health care system and insurers, particularly Medicare.
The story detailed the relative harms of earlier mammograms, but did not translate those percentages into absolute numbers. For instance, women who were diagnosed with breast cancer 25 months or more after their last mammogram were “50 percent more likely” to need chemotherapy, “32 percent more likely” to need mastectomy, and “66 percent more likely” to need lymph nodes removed. However, relative risk can be misleading, sometimes inflating numbers to sound scarier than when absolute numbers are used.
Also, we don’t know what kind of risk these women had at baseline, so it’s hard to know if they were higher risk.
The story made no mention of the harms of earlier or more frequent screening, which have been documented time and time again. More screening can mean more false positives or more finding of breast changes that lead to more testing, such as biopsies, more costs, and more worry.
The story did make clear some of the weaknesses of the study: The study found an association but did not prove causality and the study population was limited to a single health care institution. The story also mentions that the findings were presented at a meeting, which means they have not undergone peer-review.
The story does not directly engage in fear-mongering. However, some of the quotes advocating for earlier and more frequent screening play into a scenario that breast cancer is lurking in every woman.
A discussion of what a woman’s average lifetime risk is would have been helpful.
The story quotes the study author and an outside source.
The story makes clear that different advisory groups have differing guidelines for what age to start getting mammograms (40 or 50 years old).
It would have been nice if the story had included examples of what makes someone higher risk or not (personal cancer history, family history, history of radiation), but we think this was satisfactory.
We believe that mammograms are well-known to be widely available. And the earlier and more frequent screening described here is not earlier or more frequent than what many guidelines recommend, so would not be expected to be denied by health insurers.
The story makes clear the distinctive aspects of this study —using avoidance of more aggressive treatment regimens as a deciding factor, as opposed to the more extreme avoidance of cancer death.
The story goes beyond what was contained in a news release on the presentation at the American Society of Breast Surgeons annual meeting.
Systematic, Criteria-Driven
Monday at #ADA2021, an infectious disease epidemiologist, a journalist, and a researcher shared perspectives on communication of risk in the era of COVID-19: http://ow.ly/ROfR30rMeE7 @AstleyCM @garyschwitzer @berthahidalgo @ADA_DiabetesPro
Shoutouts to @susan_bewley @drkevinknopf @MichaelBaum11 in this call for more than fawning coverage from press releases for these kinds of stories.
Also, linked history inside goes back 5 years just on Grail apparently trying to become Holy Grail. https://twitter.com/garyschwitzer/status/1408849696416841731
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