Sunday, October 22, 2006

Are U.S. Breasts Different?

Or is it just how we look at them?

OK, now that the headline has hooked you... here's my question: why did a review of studies examining the balance of risks and benefits of mammography get widespread coverage in the UK, but almost no mention in the US news media?

Of the two dozen stories picked up in a Google News search, almost all were from the UK, Australia and other Commonwealth nations... but there were no US news stories found. The story hasn't appeared on, or mentioned it only in its international section as part of a world news digest.

The systematic review of major mammography studies concluded that women who get mammograms are about 15% less likely to die of breast cancer... but they are also much more likely to undergo unnecessary treatment. The review concluded that for every 2,000 women who are invited to get mammograms for 10 years, one potentially lethal cancer will be detected and successfully treated. However, 10 healthy women will be treated for cancer unnecessarily. And an additional 200 women will be given false positive results.

Inform or Persuade?

The BBC and others had headlines like: "Breast Screening Concerns Raised" and "Researchers Question Benefits of Breast Cancer Screening."

Meanwhile, US news outlets ran story after story on breast cancer (October is National Breast Cancer Awareness Month)... but almost none mentioned the potential downsides of mammography. The "rah-rah" leads of these stories advocated mammography for every woman without reservation... stating flatly that "Mammograms are good" and "No more excuses for not getting mammograms."

It seems British and Australian editors have a different view from those in the US about what sort of info is relevant to their readers and viewers.

Is it the job of journalists to inform women about mammography... the benefits and the risks? Or should journalists follow the lead of breast cancer advocacy groups... and avoid talking about any doubts or skepticism, for fear such questions might dissuade some women from getting screened?

This latest review of the science... from the Cochrane Collaboration... concludes that, on balance, mammograms do reduce breast cancer deaths... but this benefit is not free.

When I mentioned this issue to some colleagues... the responses varied.

One journalist at said that they had indeed reported on the Cochrane review.

Another wrote that
wrote, "I pitched an article covering both the benefits and risks of mammography to several magazines, but so far, no one is going for it."

And then a couple of MD's ran to the defense of mammography. "It is very-well established that mammograms in the U.S. save lives, and we don't want to discourage women from getting them," wrote one physcian/journalist.

Mammography isn't the only medical topic that generally gets a free pass from US journalists. Screening tests of all types tend to be seen as inherently good... when reality is more complicated. Most reporters and editors report without question the assertion that early detection saves lives. But the fact is that screening tests often lead to further tests, anixiety and even treatment that does not always improve health or extend life.

But I'm digressing into another large and thorny issue.

What do you think? Can women handle the news that mammography is not perfect... and that the promise of life-saving detection comes with hazard of anxiety and unncessary treatment?

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