On September 7th, NBC’s Andrea Mitchell told viewers that on a “personal note” she was “now among the one in eight women in this country…who have had breast cancer.”
In her one-minute reveal about how her summer vacation ended with a diagnosis instead of a hiking trip, Ms. Mitchell assured viewers that her breast cancer was found “during her annual screening…at its earliest stage,” and that it “had not spread.” As evidence of her successful treatment, she said, “I’m already back at work with a terrific prognosis.” Ms. Mitchell went on to share that “supporting research for breast cancer prevention and cures” is a cause that has always been important to her but that she now has a much deeper personal connection. Before ending with a statement of gratitude to her doctors, family, co-workers, and viewers, Ms. Mitchell stated unequivocally: “For you women out there, and for the men who love you, screening matters. Do it. This disease can be completely curable if you find it at the right time.”
Almost immediately, the content and framing of Mitchell’s statement raised concerns. Katherine O’Brien of the ihatebreastcancer blog wrote an open letter to Ms. Mitchell explaining that while she was sorry to learn of her breast cancer diagnosis, “early detection is not a breast cancer cure.” O’Brien, who has been living with metastatic disease since 2009, also has a deep connection to the cause of breast cancer. As the title of her blog suggests, she hates it! But O’Brien’s writing is about more than telling the dark and angry side of the breast cancer story. It’s about setting the record straight. Since she started her blog only six months ago, O’Brien has been committed to correcting the wealth of misinformation that passes for truth in the public world of breast cancer.
O’Brien’s letter to Mitchell was clearly articulated and quickly got to the point: Unless you were diagnosed with a non-invasive pre-cancer (stage zero), there is no “had” with breast cancer. Incidentally, even those diagnosed with stage zero still have a chance of developing an invasive breast cancer at some point in their lifetimes. It is a risk factor for future cancer, and there is no guarantee. Additionally, those treated for pre-cancers still face complications and side effects sometimes long after their treatment ends. However, O’Brien’s focus was on invasive breast cancer — that 75% of total cases which has the capacity to spread and take over vital organs (i.e., 25 % of all breast cancer cases are the stage zero, “in situ” type.) Even after treatment, invasive breast cancers can return and wreak havoc in the body and cause death. Of course, they might not return too but it is unknown when or in what women a recurrence will happen. Unlike Mitchell’s pronouncement, breast cancer is not “completely curable.” As O’Brien accurately states, “About 20 to 30 percent of women originally diagnosed with Stage I, II or III breast cancer will go on to have a recurrence.” Recurrence increases the probability of metastasis (i.e., when cancer cells spread to other organs of the body). The more than 40 thousand deaths from breast cancer each year–regardless of stage at diagnosis–result from metastasis and/or complications from its treatment.
In addition, the assumption that early detection leads to cure does not take the microbiology of cancer into account. Dr. Susan Love, who has not weighed in specifically on the Mitchell situation, frequently argues that not all breast cancers are created equal. She writes in her blog: ”Some breast tumors are so slow growing and are so unlikely to spread that they will never do any harm. Others grow and spread very quickly. The idea that they all can be “caught early” is wishful thinking.” Dr. Deanna Attai commented on Health News Review (which also critiqued the framing of Mitchell’s message), that “biology trumps staging” and the “assumption of being ‘cured’ based on early detection is unfortunately, wrong.” Yet, some public figures and breast cancer campaigns continue to promote the early detection mantra without question.
The postings and comments about Mitchell’s announcement revealed other problems as well, particularly her misuse of the “1 in 8″ statistic and the unquestioned directive that women get screened.
Contrary to Mitchell’s statement, one in 8 women in this country have not had breast cancer. Whereas the National Cancer Institute reports that only 1 in 233 women will be diagnosed with breast cancer from birth to age 39, the ratio changes to 1 in 29 between the ages of 60 and 69. By the time they would die of old age; about 1 in 8 women who avoided equally serious life-threatening events while they were younger would likely to be diagnosed with breast cancer. Seven out of 8 will not. Unfortunately, the “1 in 8” ratio is commonly misused or used out of context, and Mitchell is not alone in misrepresenting it. Jennifer LaRue Huget of The Washington Post argues that “the ’1 in 8′ figure has long served as the basis for a macabre parlor game for women: If I’m in a room with seven other gals, it spurs us to speculate, which one of us will get breast cancer?” Ads and campaigns frequently use the statistic to create a sense of urgency and legitimize their role in the cause. BMW states in pink fine print: “1 in 8 women will develop breast cancer. Will it be someone close to you?” Fear mongering runs rampant as corporations and organizations capitalize on public concern about breast cancer. Journalists, on the other hand, have a responsibility to ensure accuracy.
It was especially unconscionable – in the midst of ongoing and heated controversy over the benefits and limitations of wholesale mammography screening – for Mitchell to tell women to get screened (i.e., “Do it”). Screening is not a silver bullet in the war on breast cancer. The reduction in mortality due to population screening is 15 – 30 percent. Dr. Otis Brawley of the American Cancer Society explains what these statistics mean in terms of actual lives:
“Mammography over the next 10 years for the entire population is going to save between 60,000 – 100,000 lives. However, there is still going to be 400,000 – 450,000 women who die from breast cancer.”
Any reduction in mortality is better than no reduction. However, the number of people dying from breast cancer outweighs how many lives are saved due to screening by hundreds of thousands. An unquestioned belief in one-size-fits-all screening gives a false impression about one’s actual chances of being saved from the disease. Brawley also notes that the belief in screening may also be impeding progress toward finding better diagnostic tools. Telling women to “do it” goes against the grain of informed decision making regardless of Mitchell’s intentions in making such a statement.
It is unfortunate that Ms. Mitchell has had to deal with a breast cancer diagnosis. As did many who voiced concern about her message, I too wish her well. However, as I commented on Katherine O’Brien’s blog:
“Misinformation and factoids about breast cancer abound, and people who have microphones and podiums have a responsibility to be clear…Journalists especially cannot be considered to be ‘only lay-people’ when they use their official platforms and/or profiles to share their personal information while directing their viewers to take some action. They are representatives, and their words carry weight…We ought to expect more of journalists and others in the public domain who have such influence.”
For more insight into the issues surrounding the content of Mitchell’s announcement and the role of journalists, read the following posts and their comments.
- “Dear Andrea Mitchell: Early Detection is Not a Breast Cancer Cure” by Katherine O’Brien of ihatebreastcancer
- “With Best Wishes for Andrea Mitchell, Some Criticisms of Her Message” by Gary Schwitzer of Health News Review
- Reprint of Schwitzer’s essay on MedPage Today.
- “Breast-Cancer Stats” by Jennifer LaRue Huget of The Washington Post
- Andrea Mitchell’s Breast Cancer by Tara Parker Pope of The New York Times