This article was edited since its original publication.
It is now widely known that the benefits of wholesale mammography screening were overpromised. Rates of overdiagnosis (i.e., when a diagnosed tumor lacks the potential to progress to a clinical stage, or is so slow-growing that the person would die from other causes) are higher than previously realized. We still do not know what causes breast cancer, how to prevent it, or why it recurs. The breast cancer that kills (i.e., metastatic) continues to strike hundreds of thousands of breast cancer “survivors” in the United States and, with bleak prognoses, more of them die each year. Rather than acknowledging what science has confirmed about breast cancer’s complexity, and what it has revealed about what is yet unknown (including why at least 70 percent of those screened do not have their lives saved as a result of that screening), groups like Komen divert public attention to an array of simple solutions.
Consider Komen’s 2011 “Less Talk. More Action” program and schedule of events.
Susan G. Komen founder and CEO, Ambassdor Nancy G. Brinker, kicks off Breast Cancer Awareness Month with a special video message encouraging you to take action. View video.
The Dallas Cowboys will be honoring breast cancer survivors at Cowboys Stadium as Amb. Nancy G. Brinker does the coin toss in the game against Detroit. Check out the following new videos as Cowboys pledge to take action if the women in their lives get screened for Breast Cancer. Video Coming Soon!
Talk to your employer about participating in the Susan G. Komen Promise Action Campaign. Major
corporations can pledge what they’ll do to encourage employees to get screened. Learn more.
Take a moment today to tell us what you would have missed if you (or someone you loved) didn’t get screened for breast cancer in time. Your story could help urge other women to get screened. Start sharing.
Feeling hungry? Learn more about “Mike’s Way to a Cure Day” at Jersey Mike’s
. . . .
Komen’s 31 days of action can be boiled down into two things: get screened and support our sponsors.
As Journalist Christie Aschwanden has pointed out, one of the real scandals at Susan G. Komen for the Cure is “Science Denialism” and the fairytale notion that breast cancer is a uniformly progressive disease that starts small and only grows and spreads if you don’t stop it in time. In reality some tumors are aggressive, and others are not; some will spread regardless of treatment, and others are not likely to spread in a lifetime; and “early detection” is a misnomer when breast cancer can recur ten or fifteen years after diagnosis regardless of initial staging. The selling of wholesale screening, along with accompanying lifestyle and product placements, replaces well-grounded hope with misleading hype.
Professors Steven Woloshin, MD, and Lisa M. Schwartz, MD, of the Department of Veterans Affairs Medical Center and the Dartmouth Institute for Health Policy and Clinical Practice, published an essay in British Medical Joural (BMJ) [2012;345:e5132] that also criticized Komen for exaggerating and distorting medical information in its 2011 advertising campaigns.
Here is the Press Release:
Breast cancer charity under fire for overstating the benefits of screeningThursday, August 2, 2012 – 10:35
Experts challenge “pink ribbon” creator for misusing statistics to generate false hope
The world’s largest breast cancer charity comes under fire from experts today for using misleading statistics to persuade women to undergo mammography.
Professors Lisa Schwartz and Steven Woloshin of the Center for Medicine and the Media at The Dartmouth Institute for Health Policy and Clinical Practice argue that last year’s breast cancer awareness month campaign by Susan G Komen for the Cure “overstates the benefit of mammography and ignores harms altogether.”
Their views are published on bmj.com today as part of an occasional series highlighting the exaggerations, distortions, and selective reporting that make some news stories, advertising, and medical journal articles “not so.”
A growing and increasingly accepted body of evidence shows that although screening may reduce a woman’s chance of dying from breast cancer by a small amount, it also causes major harms, say the authors. Yet Komen’s public advertising campaign gives women no sense that screening is a close call.
Instead it states that the key to surviving breast cancer is for women to get screened because “early detection saves lives. The 5-year survival rate for breast cancer when caught early is 98%. When it’s not? 23%.”
This benefit of mammography looks so big that it is hard to imagine why any woman would forgo screening. But the authors explain that comparing survival between screened and unscreened women is “hopelessly biased.”
For example, imagine a group of 100 women who received diagnoses of breast cancer because they felt a breast lump at age 67, all of whom die at age 70. Five year survival for this group is 0%. Now imagine the women were screened, given their diagnosis three years earlier, at age 64, but still die at age 70. Five year survival is now 100%, even though no one lived a second longer.
Overdiagnosis (the detection of cancers that will not kill or even cause symptoms during a patient’s lifetime) also distorts survival statistics because the numbers now include people who have a diagnosis of cancer but who, by definition, survive the cancer, the authors add.
“If there were an Oscar for misleading statistics, using survival statistics to judge the benefit of screening would win a lifetime achievement award hands down,” they write.
But that doesn’t stop people from misinterpreting survival statistics. Disturbingly, in a recent survey, the authors found that most US primary care doctors also mistakenly interpret improved survival as evidence that screening saves lives.
Mammography certainly sounds better when stated in terms of improving five year survival – from 23% to 98%, a difference of 75 percentage points, they say. But in terms of its actual benefit, mammography can reduce the chance that a woman in her 50s will die from breast cancer over the next 10 years from 0.53% to 0.46%, a difference of 0.07 percentage points.
The Komen advertisement also ignores the harms of screening, they add. For every life saved by mammography, around two to 10 women are overdiagnosed. These women cannot benefit from unnecessary chemotherapy, radiation, or surgery. All they do experience is harm.
“Women need much more than marketing slogans about screening: they need – and deserve – the facts,” conclude the authors. “The Komen advertisement campaign failed to provide the facts. Worse, it undermined decision making by misusing statistics to generate false hope about the benefit of mammography screening. That kind of behaviour is not very charitable.”
To contact the authors, please call Annmarie Christensen, The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire, USA firstname.lastname@example.org
The late Rachel Cheetham Moro wrote considerably about the oddities and the failings of breast cancer culture on her blog The Cancer Culture Chronicles, and particularly those of the leading breast cancer charity, Komen. In a review of Komen’s October Awareness Activities that pointed to the real flaws of its fundraising/awareness-focused screening agenda, Rachel pointedly asked:
“How dare Komen so FALSELY suggest that a screening mammogram is all it takes to avoid metastatic breast cancer? How dare Komen so CRUELLY suggest that “not getting screened for breast cancer in time” would be THE reason and the FAULT of the person with metastatic disease who misses out on all the experiences and joyous events of a long and healthy life that so many others take for granted?”
Today would have been Rachel’s 42nd birthday. She died of metastatic breast cancer on February 6, 2012.