I was taken aback a moment ago when I came across a Facebook update from yesterday posted by a Komen Affiliate. It was advertising free mammograms. There is nothing wrong with offering free mammograms per se, but the announcement included a heavily scrutinized advertisement that claims getting screened is the key to surviving breast cancer. It isn’t. If concern about Komen’s misrepresentation of scientific information sounds familiar, it’s because we’ve already been over this.
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, criticized Komen’s 2011 “Get Screened Now” campaign for exaggerating and distorting medical information. In an article published in the British Medical Journal (BMJ), the researchers pointed out serious informational flaws in the widely disseminated ads, including the one attached to the bottom of the Komen Affiliate’s Facebook announcement. I wrote about the BMJ article and Komen’s misuse of statistics in said campaign last year in “The trouble with Komen: Misusing statistics/Generating false hope.”
Instead of screening being “the key” to surviving breast cancer as the advertisement states, evidence shows that screening may reduce a woman’s chance of dying from breast cancer by a very small amount (0.07 percent for a woman over age 50). The campaign also had another flaw (not visible in the cropped version of the ad). It said that, “the 5-year survival rate for breast cancer when caught early is 98%. When it’s not? 23%.” The researchers pointed out that,”five-year survival statistics are biased due to “lead time” (the time difference between when a cancer can be diagnosed with screening and when it can be felt) and “overdiagnosis” (when cancers are detected that never would have been life threatening or caused symptoms in a persons lifetime.) Woloshin and Schwartz also noted that the advertisement completely ignored the harms of screening, including false alarms, unnecessary testing, and the greater chance of being treated with surgery, chemotherapy, or radiation without actually benefitting from those treatments.
From everything I’ve researched on the topic, what’s clear to me is that a one-size-fits-all approach to screening hasn’t worked, and screening is a personal decision based on individual risk profiles. H.G. Welch MD explains that the mortality benefit of mammography is much smaller, and the harm of overdiagnosis much larger, than has been previously recognized; calls for recognizing the harms and benefits of screening; and recommends redesigning screening protocols to reduce overdiagnosis or stop population-wide screening completely. “Screening,” he writes, “could be targeted instead to those at the highest risk of dying from breast cancer — women with strong family histories or genetic predispositions to the disease. These are the women who are most likely to benefit and least likely to be overdiagnosed.”
Screening as a diagnostic tool has not been disputed, but the data hasn’t supported its use as a pre-emptive strike for all women to use against breast cancer mortality. Yet, a followup about the Komen campaign from the Breast Cancer Consortium pointed out that in the months since the uproar about the charity’s science denialism, Komen started to remove evidence of the “Get Screened Now” campaign. The URL in the advertisement komen.org/getscreened vanished from the website and now points to the default home page. A related “Promise-Action” page no longer links to the primary website, but it still comes up in a list if you enter “promise-action” in the Komen search box. http://ww5.komen.org/promise-action.html.
“Komen has been so successful in spreading the message that mammograms are the key to surviving breast cancer,” BCC writes, “that without an equally strong campaign to clarify the overstatement, misinformation about mammograms will continue to abound within the Komen empire and beyond.” As of August 7th, 2013 we can add this most recent Facebook announcement to the running list of Komen materials still using the same distorted and exaggerated messaging about screening.
Note: This essay was edited since its original posting.
When is this distorted and exaggerated messaging from Komen going to stop? They just keep repeating the same mistakes. It’s systemic.
It’s astonishing. First the organization denies any problem. Then it slowly removes evidence of the advertisement from key areas. Then it keeps using the messaging, piecemeal, in its materials. Enough it enough.
So if early detection does not save lives and mammograms are not necessary what is your recommended approach to being screened and/or treated for breast cancer?
Dear Confused: Thank you for your question. From everything I’ve researched on the topic, what’s clear to me is that a one-size-fits-all approach to screening hasn’t worked, and screening is a personal decision based on individual risk profiles. Here is a good piece by H.G. Welch MD that I think makes sense. It acknowledges that the mortality benefit of mammography is much smaller, and the harm of overdiagnosis much larger, than has been previously recognized; it calls for recognizing the harms and benefits of screening; and it recommends redesigning screening protocols to reduce overdiagnosis or stop population-wide screening completely. “Screening could be targeted instead to those at the highest risk of dying from breast cancer — women with strong family histories or genetic predispositions to the disease. These are the women who are most likely to benefit and least likely to be overdiagnosed.” Screening as a diagnostic tool has not been disputed, but the data hasn’t supported its use as a pre-emptive strike for all women to use against breast cancer mortality. People in high-risk categories are most likely to benefit. There is more information on this site about the mammography controversy if you want to read more. — Gayle Sulik
Its much clearer now. From reading this article and one similar to it I got the impression that mammography and chemo/radiation treatment should be thrown out the door. What you are saying is that such screenings/treatments should be rethought so persons who don’t need it don’t have to endure these services unnecessarily. Gotcha
Yes. In fact, I’ll add this explanation to the post in case others were also confused. Thank you, again!