Miscommunicating the Science of Mammography

The more we discover about cancer screenings, it seems, the less clarity there is about who should have them, when and what to do about the results. Mammography is one of the more common footballs being kicked around in the best-practice screening arena, and we’ve regularly covered the news about this imaging test.

So has Gary Schwitzer on HealthNewsReview.org, whose recent post reviews the difficulty many media have in reporting results of mammography studies that are accurate, nuanced and provide the context people need to make informed decisions about what’s best for them.

This time, Schwitzer refers to a recent study in the Journal of the American Medical Association (JAMA) called “A Systematic Assessment of Benefits and Risks to Guide Breast Cancer Screening Decisions.” If that title doesn’t speak to the ongoing debate about who-when-why, nothing does. “It reached a conclusion,” Schwitzer writes, “that you might think few could disagree with – although on this topic one should never underestimate the potential for disagreement.”

The researchers concluded that although mammography screening appears to be associated with reduced breast cancer mortality, the harms of screening might outweigh the benefits for some people. They say that research priorities should be: better screening methods; better understanding of their harms; better strategies to identify the highest-risk patients; and tools to help them and their doctors make screening decisions.

An editorial accompanying the study addressed the challenge of teasing out all the factors that should be considered in mammography decisions. Drs. Joann Elmore and Barnett Kramer said that the “nuanced balance is not easily communicated.” They say that the federal government’s policy on insurance coverage of mammography doesn’t help this communication:

With the goal of improving access to preventive services and medical screening, the Affordable Care Act (ACA) offers free screening mammography to women. However, women often pay for the consequences of screening, even if the screening examination is free. Women bear not only financial charges but also important human costs. Screening mammography can trigger recalls for more testing, biopsies, mastectomies, radiation, systemic therapy, days off work, and debt related to health care costs. These byproducts of screening can lead to adverse financial consequences and personal harm. … Balanced messaging is essential to help each woman make her own individual decision regarding her participation in screening mammography.

“Nuanced balance,” Schwitzer says, is not what you’re generally going to find in the news.

  • A Washington Post headline: “Despite strong benefits, mammograms may have greater harms than previously realized, study says.”

    The story refers to “substantial” benefits, but the JAMA study doesn’t refer to “strong” or “substantial” benefits. The story quotes one study author that the results are “profoundly disappointing that mammography doesn’t quite live up to its promise. …it does not show as strong a benefit as is often suggested in the media.”

    Schwitzer’s legitimate gripe is that “strong and substantial” and “profoundly disappointing and not as strong as suggested in the media” appear in the same story without, apparently, awareness of the contradiction, or the need for interpretation.

  • An announcement on a TV station in Hawaii: “Mammogram benefits outweighs risks, new study says.” Except that it didn’t.
  • A Society of Breast Imaging (SBI) news release titled “JAMA Article Breast Cancer Screening Recommendations Potentially Deadly for Many Women.” Never mind, Schwitzer says, that the JAMA article only reviewed the evidence; it didn’t make any direct recommendations about screening, only that such decisions should be individualized based on patients’ risk profiles, preferences and an improved understanding of potential harms.

    The SBI, by the way, states that it “seeks to minimize the possibility and appearance of inappropriate influence from outside parties.” It paid to place an exhibit at a recent convention of health-care journalists.

“Nuanced balance?” Schwitzer concludes. “You be the judge.”

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