Here We Go Again: Breast Cancer Screening Story Steeped in Politics, Rather than the Evidence

Once again, we’re seeing the confusion and controversy surrounding breast cancer screening being used as a political tool by those who know little–or care little–about the evidence.  Earlier this week, an NPR Morning Edition report ran with the misleading headline, “Congress May Be Forced To Intervene Again On Mammogram Recommendations.”  And the headline was only the beginning of an imbalanced story filled with misconceptions, gaps in context, and misunderstanding of the science.

The story, which was from a political reporter (and not a science or healthcare reporter), Juana Summers, discussed the most recent developments this year following the U. S. Preventive Services Task Force (USPSTF)’s 2009 recommendation that routine screening mammograms for average-risk women should begin at age 50, rather than 40 years.  As outlined in the recommendations, for those ages 40 to 49, screening mammography has not been shown to decrease mortality due to breast cancer, yet the evidence does show that such screening is associated with a significantly higher number of false positives, with resulting unnecessary biopsies and worry.  In addition, what is often lost or not sufficiently stressed in media coverage is that these recommendations do not apply to women with increased risk for breast cancer (e.g., family history, known BRCA1 or BRCA2 mutation, chest radiation).  The Task Force’s recommendations were aimed at reducing the very real harms for women at average risk, including unnecessary further tests as described above, as well as preventing overdiagnosis and overtreatment–e.g., the detection of ductal carcinoma in situ (DCIS), sometimes called “stage 0,” which in most cases will never go on to become invasive, resulting in unnecessary aggressive treatment interventions.  However, due to no or poor reporting of the science behind these recommendations, the resulting public outcry, and political jockeying, legislation was passed by Congress overriding the Task Force’s recommendations.

mammogram controversy

As the USPSTF now moves ahead with an update of these guidelines–where a draft released earlier this week shows that the Task Force “essentially repeated its earlier recommendation”–Summers reported that another political firestorm appeared to be on the horizon.  And the online article’s headline, “Congress May Be Forced to Intervene Again …” certainly suggests that Congress has “no choice” but to step in again.

Summers’ story began with comments from Debbie Wasserman Schultz, Florida Congresswoman and Chair of the Democratic National Committee (DNC).  Though she was diagnosed with breast cancer herself, and although she describes herself as a breast cancer advocate, I would argue that Schultz has a tendency to focus on the emotional, the sensational, and the politically expedient, rather than the evidence when she discusses these issues.  Witness the following:

In Summers’ report, Schultz says, “Forty-one – I was – I had just had my first mammogram a few months before I found the lump.”  Summers states, “That is Debbie Wasserman Schultz … Diagnosed at 41 years old, she says that if the recommendation had been in place, she may not have gotten a mammogram and her own cancer wouldn’t have been caught early. What’s more, she says the task force is essentially handing women a death sentence.”  Schultz then says, “We know that there are women that [sic] will die if this recommendation goes through.”

U.S. Representative Schultz speaks during the Reuters Washington Summit in Washington

But didn’t Schultz say that she had had her first mammogram a few months before she found a lump herself?  In looking into this further: in a 2013 Glamour Magazine interview with Schultz, she noted: “My diagnosis was a couple of months after a clean mammogram. I had aggressive breast cancer, and it grew fast from the time I had my mammogram, or it was there and the mammogram missed it. Nothing is foolproof. You can’t make yourself crazy, but you have to be vigilant.”

So apparently screening mammography did not detect her breast cancer.  Though one anecdote, her own story does not support the case she is trying to make so vociferously.

But I was pleased to see that a subsequent article in NPR Ombudsman by Elizabeth Jensen, entitled “Political Story on Breast Cancer Screenings was Missing Some Science” (though the word “some” is perhaps a bit generous).  Jensen explains that Summers’ report drew strong criticism, including from physicians who had serious concerns about the lack of context and no explanation of the evidence behind the Task Force’s recommendations.  They felt that a more nuanced discussion of this complex issue is required, where the reasoning behind the recommendations is explained and a careful balance is suggested in weighing potential benefits against possible harms in the context of individual patient needs.

And back to the politics. In writing about the original NPR piece, Gary Schwitzer of HealthNewsReview.org noted that several politicians were quoted, with all showing their opposition to the Task Force recommendations.  In contrast, however, he stressed that “the 4-minute piece had no interview with anyone with the Task Force. Not a quote.  Not a word. That’s imbalance.  You can talk about bipartisan opposition all you want.  But on a scientific controversy, citing bipartisan opposition doesn’t equate to balanced or sound journalism.”

Though the angle of the story was chosen to be a political one, there is no getting beyond the fact that it’s about an important, complex medical issue.  Many of us would submit that much of politics is about obfuscation, and that is frustrating to say the least–but that can become downright dangerous when scientific questions are pulled into the mix and being on the “right side” of the issue becomes more important to many than the evidence.  NPR did a disservice to its listeners and readers by not providing a clear explanation of the Task Force’s recommendations, not interviewing anyone on the Task Force, interviewing solely politicians who voiced disagreement with the recommendations and were uninformed about the science and/or had other concerns, and perpetuating the controversy, confusion, and misunderstanding about this important issue.

As Schwitzer so rightfully concluded, “If we once again allow news coverage of this issue to be dominated by politics–and by coverage that delivers a superficial thumbnail sketch of a scientific controversy –we will have done more harm to women and to all news consumers than anything we can do with mammograms or without them.”