A Call for Responsible Reporting: NBC’s Andrea Mitchell Misstates the Value of Mammography Screening in the Wake of her Breast Cancer Diagnosis

Andrea Mitchell MSNBC

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.”

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.”

Outrage Erupts to Set the Record Straight

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.  Even those diagnosed with stage zero breast cancer have a chance of developing an invasive breast cancer during their lifetimes. Any breast cancer diagnosis is a risk factor for future cancer. Additionally, those treated for pre-cancers still face complications and side effects sometimes long after their treatment ends.

O’Brien’s focus, however, 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, but it is unknown when or in what women a recurrence will occur. Unlike Mitchell’s pronouncement, breast cancer is not “completely curable.”

O’Brien accurately states that “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.

Biology Matters

The assumption that early detection leads to cure also 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.

Statistics Out of Context

The postings and comments about Mitchell’s announcement revealed other problems as well, particularly her misuse of the “1 in 8” statistic along with the unquestioned directive that all women get screened.

Contrary to Mitchell’s statement, one in 8 women in the United States has not been diagnosed with breast cancer. That’s a cumulative lifetime probability.

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 Advertisement: “1 in 8 women will develop breast cancer. Will it be someone close to you?”

BMW states in pink fine print (left): “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.

Mitchell’s directive that all women get screened (“Do it”) was especially unconscionable in the wake of ongoing and heated controversy over the benefits and limitations of wholesale mammography screening. The reduction in mortality due to population screening is not 100 percent but may be between 15 and 30 percent if that.

Dr. Otis Brawley of the American Cancer Society explains what these statistics mean in terms of actual lives:

Dr. Otis Brawley

“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 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 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.

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12 comments to A Call for Responsible Reporting

  • I am another person who expressed uneasiness concerning Ms. Mitchell’s statements. Undoubtedly, her intentions were good. Her announcement made me wonder once again why there seems to be this tendancy to downplay the seriousness of breast cancer. It seems there is this prevalent mind set that says if you just catch it early everything will be fine and of course, this is not always the case. As I’ve said before, Ms. Mitchell is a high-profile journalist, and her words will be scrutinized even when she is telling her personal story. She needs to choose her words more carefully and be sure her facts are correct. “A Call for Responsible Reporting,” isn’t that what we all want and deserve? I know I do.

    Great post. Once again your responsible voice of reason comes through.

  • This is an important discussion, Gayle.

    Breast cancer is a complex and complicated disease that no longer translates into sound bytes. Even the old “one in eight” isn’t as simple as it appears, yet this is the information Andrea Mitchell relayed when she made her “personal announcement” about her cancer.

    I won’t criticize a journalist for announcing his/her cancer. But I agree that – as a journalist – she take the opportunity to accurately relay the facts about this disease.

    After hearing about many difficult cancer cases last week my first reaction when I heard Ms. Mitchell’s announcement was, ‘thank heavens someone thinks she’s DONE.’

    Unfortunately, more accurately, we know all too well that not all women will be.

    Jody

  • Mary

    I must confess, I did a double take when I heard Ms. Mitchell’s announcement, as well. While I wish her only the best and good health in the future, I am pleased that this discussion is taking place. It has been my experience, that too many of those diagnosed and treated for BC are unaware of the true situation regarding this insidious disease and their possible future because of it. I blame it on media brainwashing and the over pinking of the disease. A big thank you to all who have been unafraid to speak the truth, on this subject! It is the only way to direct the billions raised, toward more productive areas of research.
    Mary

  • Janet

    I really don’t understand the hullaboo about this. First, I think your post is misleading in its title. Andrea Mitchell wasn’t “reporting” when she told her story. Second, you said:

    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.”

    WHY is it unconscionable for her to encourage screening when it does in fact reduce mortality in the population by 15 to 30%? That’s 60,000 to 100,000 lives that are saved by screening, according to ACS. That is not insignificant, certainly not for the men and women who fall into that number, nor for their family and friends.

    I understand that it is not the silver bullet way to stop breast cancer, but for those who fall into this 15-30% (and presumably Ms. Mitchell) it surely matters. I understand that there is a greater percentage who are not included in this number, but that doesn’t change the fact that screenings do save lives.

  • Janet, thank you for commenting. In this case, the term reporting is referring to ‘giving an account.’ The fact that a reporter is the one giving that account is part of the concern about Mitchell’s announcement. Where is the line drawn between the personal account and the journalistic platform?

    I chose the word ‘unconscionable’ to describe Mitchell’s directive that women “do it” (i.e., get screened) because it was indeed a directive. There was no mention of the ongoing concerns about screening even though this debate has been ongoing for a decade. I agree with you completely that for the 15 to 30 percent of people whose lives are saved due to screening, it certainly matters. Shall we just forget about those other hundreds of thousands for whom it does not? In this situation, I agree with Brawley that the wholehearted belief in screening has been a limitation to thinking more fully about the risks, benefits, and limitations of this technology.

  • Leslie enlow

    Great post,Gayle. I Gree with you and the other comments.

  • Sally Drees

    Dr. Sulik – Great post, great message and one I firmly believe in. I have stage IV BC, my original diagnosis was “caught early” at stage two, yet I recurred 4 1/2 years later to my ovaries/abdominal cavity. I could sit and dwell on my likely demise from this horrific diesase, but I have chosen a different path. I am on a mission to get the word out about the less than pink and fuzzy side of BC and am trying to move to ACTION with my project – THE 31 Day Project – a mission to raise 41k in 31 days to go toward helping women currently treating for BC and help fund the 2012 annual research grant from METAvivor into MBC. We have the awareness, what we need is action. Less than 2% of all dollars raised for BC research goes to MBC – the cause of 100% of all BC deaths. 41,000 men and women die every year in America from MBC. I would love if you would check out my cause and help me http://www.causes.com/causes/632480-the-31-day-project-moving-beyond-awareness

  • Thank you Gayle for this very clear piece about this announcement. I too, like Nancy, continue to wonder why there is this downplaying of the seriousness of breast cancer – and you have very accurately analysed all the information here. I suspect that our fear of breast cancer, knowing how serious it is, that it is a life-threatening disease, may contribute to a sense of wanting to believe we can ‘catch it early’, and that we can be ‘cured’? Unfortunately, as you have shown, this is not the case.
    Here in the UK the lifetime risk figure recently increased from 1 in 9 to 1 in 8, now in line with the US. And it pretty much passed without comment. Whilst it’s fair to say that this overall statistic could be used to alarm women in the way you have outlined, I think the more important issue here is that the statistics are increasing, not decreasing. So overall lifetime statistics have increased from 1 in 10 in the 1970s; but it’s also steadily increased in all women’s ages, whatever decade you look at. To me, that’s not good enough.
    I am the “1 in 69” statistic, diagnosed age 43, which doesn’t begin to sum up my life since diagnosis and the amount of treatment and surgery I’ve been through (and continue to have) now approaching five years from diagnosis. Plus the fact that my life is changed forever by the disease. By simplifying the way we talk about breast cancer we do a disservice to the women whose lives are so changed by this unpredictable and insidious disease.
    Sarah

    The NCI list the statistics as follows:
    A woman’s chance of being diagnosed with breast cancer is:

    from age 30 through age 39 . . . . . . 0.43 percent (often expressed as “1 in 233”)
    from age 40 through age 49 . . . . . . 1.45 percent (often expressed as “1 in 69”)
    from age 50 through age 59 . . . . . . 2.38 percent (often expressed as “1 in 42”)
    from age 60 through age 69 . . . . . . 3.45 percent (often expressed as “1 in 29”)

    http://www.cancer.gov/cancertopics/factsheet/detection/probability-breast-cancer

  • Excellent point, Sarah. Fear mongering aside, these statistics over time show a rise in incidence across age groups. From an epidemiological perspective, this suggests a shift. The NCI still argues that there is no epidemic, that the rise in cancer incidence is the result of a growing and aging population. But, when the numbers are age and population adjusted, there is still more cancer.

  • Jean

    I must say that I am grateful to all those questioning Ms. Mitchell’s on air announcement. Before I started exploring these various blogs I was woefully uninformed about breast cancer. I am generally tired of the media (both on air and print)reporting in short segments about various medical “breakthroughs”, screenings, recommendations, etc. without adequate time given to risk/benefit information and other subtleties. I understand that there are time constraints but I don’t think that justifies the problem of mis-informing or under-informing the general population. What happens is we get a lot of fear/disease mongering along with the cutesy-fying (can’t think of a better word) of breast cancer “prevention”, mostly by stressing mammograms as a means of early detection. Especially insulting to me are the current ads I’ve seen in various magazines using slogans such as “Save the ta-tas” and “Do it for the girls”. It’s totally inappropriate in my opinion.

  • Jan Hasak

    Gayle, you said it so well. Too many public figures in the role of influencing others minimize the impact of breast cancer on those who have been diagnosed. Biology indeed does trump stage when it comes to this disease. And we don’t fully understand the biology at this point in time. We’ve only reached the tip of the research iceberg. I hope the powers-that-be listen to voices like yours so that we can end this myth of catching it early by screening and living happily ever after.
    XOXO,
    Jan

  • Gayle, thank you for writing this post. Regardless of whether we are victims of pinkwashing or fearmongering, neither is accurate, and both distract from where our focus needs to be which is research to end it. Many women have been lulled into the belief that mammograms and eating our vegetables is enough. Reporters have an obligation to educate, not contribute to cultural myths! After facing Inflammatory Breast Cancer in 2007, I want to retch every year as the October Pink Fest approaches.

    You Rock!
    Elizabeth

To speak her truth, she needed to give her words and identity away, to a trusted poet and friend @stevedavenport breastcancerconsortium.net/ov…

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* GAYLE IN THE MEDIA *

"Seeing clearly through the pink haze" Toronto Sun

*Sad face*: Being happy does not help you live longer" New Scientist

How should we address breast cancer when norms continually change? The Guardian

Your Fun 'No Bra Day' Photos Are Overshadowing Terminal Breast Cancer Patients Broadly

Backlash against “pinkwashing” of breast cancer awareness campaigns BMJ

Breast Cancer to Rise 50 Percent by 2030? Hey, Not So Fast! Health News Review

Breast Cancer: The Flaws in the Cause iafrica.com

How to Make the Biggest Impact With Your Breast Cancer Donations Money

The Very Pink, Very Controversial Business of Breast Cancer Awareness Racked

NFL, Pink Ribbons Not Enough to Win over Women CNN

3 Questions We Need to Answer for Breast Cancer Awareness Month Chronicle of Philanthropy

The problem with National Breast Cancer Awareness Month Women's Health Magazine

Pink Ribbon Envy: Living with an Uncool Cancer The Nib

A Year After Bombings, Some Say 'Boston Strong' Has Gone Overboard NPR, All Things Considered

Canadian Mammogram Study KCRW, NPR Affiliate

Time to Debunk the Mammography Myth CNN

Breast Cancer: Awareness, Activism & Pinkwashing NPR Charlotte

Buying Pink Al Jazeera's The Stream Watch »

The Pink Backlash Orlando Sentinel

Why Jolie's Test Costs So Much CNN

Preventative Mastectomies: Disease and Deception BlogTalkRadio

Angelina Jolie and the 'Breast Cancer Gene' KCRW

Our Feel-Good War on Breast Cancer The New York Times Magazine.

The Story Behind the Pink Ribbon Campaign Sisters Talk Radio

WISH Interview Women's International Summit for Health

Making Cancer About The Patient, Not The Body Part CBS Pittsburgh

Sexy breast cancer campaigns anger many patients USA Today

The perils of pink The Daily

Komen pink campaign creates breast-cancer blues for some Dallas Morning News

A yellow flag for the NFL's pink New York Daily

Gayle Sulik named #7 in SharecareNow’s Top 10 Online Influencers in Breast Cancer

Breast cancer cancer causes so easily derailed Philly Inquirer

Komen Charity Under Microscope for Funding, Science Reuters

The Fight Against Cancer - And Abortion? Salon.com

Susan G. Komen For the Cure defunds Planned Parenthood. In Deep with Angie Coiro

Amid Breast Cancer Month, Is there Pink Fatigue? NPR's All Things Considered

How is Breast Cancer Culture Undermining Women's Health? America’s Radio News Network

Pink Ribbon Culture and Breast Cancer The Kojo Nnamdi Show

The Big Business of Breast Cancer
Marie Claire

Does Breast Cancer Awareness Month Crowd Out Other Diseases? Slate

Pink Inc. Has Many Starting to See Red The Sacramento Bee

Get Your Pink Off Ottawa Citizen

Komen Pink Ribbons Raise Green and Questions USA Today

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