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Thorough, thoughtful coverage of Task Force’s final mammogram recommendations

Panel Reasserts Mammogram Advice That Triggered Breast Cancer Debate

Our Review Summary

MammogramThe story provides an excellent overview of new recommendations from the U.S. Preventive Services Task Force (USPSTF) on when, and how often, women should receive mammograms to screen for breast cancer. The story discusses the long-running debate over mammogram recommendations, as well as the differing advice that various organizations provide on when women at average risk of breast cancer should begin mammogram screening and how often they should have the tests, though the story would have been stronger if it had explained what “average risk” means (something that a competing Washington Post story on the recommendations explains well). The story also offers a good discussion of issues related to what the USPSTF recommendations may mean for insurance coverage of mammograms, though it does not tell readers how expensive mammograms may be without insurance.


Why This Matters

Breast cancer screening is a big deal. As the CDC notes, “Not counting some kinds of skin cancer, breast cancer in the United States is the most common cancer in women, no matter your race or ethnicity.” In 2012 alone, 41,150 women died of the disease. Breast cancer also has a profound impact on the economy, with researchers estimating that it costs the U.S. billions of dollars each year. In other words, it affects the health and well-being of millions of patients and their loved ones, as well as having an adverse impact on the economy. News that relates to the early detection and treatment of breast cancer is clearly news worth covering, particularly when it could inform the decision-making of women and health professionals — and have an effect on women’s access to screening.


Does the story adequately discuss the costs of the intervention?

Not Satisfactory

The story does a good job of explaining how the USPSTF recommendations may affect insurance coverage of mammography screening — which is laudable, given the complexity of the issue. However, the story does not tell readers the bottom line: how much would a mammogram cost if it were not covered by insurance? While we found varying estimates, a 2011 paper stated that the overall cost of a mammogram was $266 — a considerable sum, and likely out of reach for many women. This was a shortcoming of both the New York Times and Washington Post stories.

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


The story does a good job of articulating the benefits of mammography screening for different age groups. For example, it notes that “For every 10,000 women screened repeatedly over 10 years, four lives are saved in women 40 to 49; eight in women 50 to 59; 21 in women 60 to 69; and 13 in women 70 to 74, the task force found.” However, the story does not explain what it means to be “screened repeatedly” — does that mean every year, or could it mean every other year? Still, we’re very happy to see the story include numbers rather than referring solely to a general increase or decrease in benefits. The story also notes that the recommendations apply only to women with average risk of breast cancer. The story would have been significantly stronger if it had explained what “average risk” means — most readers probably don’t know.

The quote from the Susan G. Komen For the Cure Foundation demonstrates the importance of reinforcing that these guidelines apply to average risk patients – they express concern that “a lack of coverage would hit ‘high risk and underserved’ women hardest” – high risk women are not affected by these recommendations.

A discussion on risk assessment is absent from most stories covering screening mammography, and has led to much confusion. One issue is that there are a variety of risk assessment models, and their use in particular patient populations is not always well understood by physicians. However, a brief discussion about how risk is assessed would be helpful for patients and others reading these stories.

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


This is really a strong point for the story. The story devotes several paragraphs to explaining — and quantifying — the potential harms of false positives and overdiagnosis. It then spends an additional two paragraphs trying to place these harms in context. For example, citing a cancer expert’s position that the potential harms are significantly outweighed by the potential benefits. The story also made clear that there was an emphasis in the recommendations that women be able to decide for themselves on when to begin screening, and how often to be screened. That’s an important point — women should know that they have a role to play in weighing risks against potential benefits and — ultimately — making decisions about their health.

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


The story does not offer a detailed description of the USPSTF review process, but it does make clear that the task force looks only at the scientific evidence, rather than at potential costs or insurance coverage. That’s enough for a satisfactory rating in a story like this one. However, the story would have been stronger if it had explicitly stated that the USPSTF bases its recommendations on an evaluation of all the available research literature on mammography and breast cancer screening.

Does the story commit disease-mongering?


No disease mongering here. The story says nothing that isn’t backed up by the numbers.

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


The story did a good job of incorporating input from multiple independent sources.

Does the story compare the new approach with existing alternatives?


The alternatives in a story like this one are the recommendations from other organizations, and the story does a good job of explaining the varying recommendations from the USPSTF and three other groups: the National Comprehensive Cancer Network, the American College of Obstetricians and Gynecologists, and the American Cancer Society. Well done.

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


The story makes clear that the use of mammograms as breast cancer screening tools is longstanding and well established. The story also discusses insurance coverage issues that would affect availability for many women. The story states, “The recommendations are not immediately expected to affect insurance coverage. In December, Congress passed a bill requiring private insurers to pay for screening mammograms for women 40 and over every one to two years without copays, coinsurance or deductibles, through 2017.”

Does the story establish the true novelty of the approach?


The story does a nice job of placing the new recommendations in context, discussing its similarities (and differences) to the USPSTF’s 2009 recommendations on mammograms and breast cancer screening — and how it fits into a broader, ongoing debate on the subject.

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


The story goes well beyond whatever could be found in a news release on the recommendations.

Total Score: 9 of 10 Satisfactory


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