"Why Patients Aren't Informed About Mammograms"
In the mammography wars, rational thinking can be easily lost.
Yes, mammograms are big business,
bringing in about 7 billion dollars a year.
But it would be a bit too cynical to believe
that the pushback from mammogram critics
stems only from the self-interest of radiologists and breast surgeons
whose daily bread depends on the continuation
of routine mammogram screening.
It just makes intuitive sense that mammograms should work.
But that's why we have science, so we can put things to the test.
We owe it to our patients to be
"evidence-based" rather than "faith-based."
They deserve an objective analysis of the data.
We've done a dismal job of accurately informing the public,
and the question is why?
Well, one reason is that the doctors themselves aren't informed.
For example, a survey of radiologists found
that 96% overestimated a middle-aged woman's risk of breast cancer.
In one sneaky study, researchers called up gynecologists
and pretended to be a concerned family member,
asking for a phone consultation about the benefits and harms of mammograms.
"Although all [the] gynecologists appeared motivated and concerned
with sufficiently answering our questions, they [simply appeared to lack the]
information as well as knowledge
of how to communicate information on medical risk."
When Doctors Meet Numbers.
"We cannot take for granted the ability of physicians
to understand and interpret [data and use it]
to the best advantage of the patient."
An educational blind spot for physicians, identified more than 80 years ago.
In this study, for example, 151 practicing physicians
were asked a series of multiple choice and true and false questions
to gauge their practical understanding of some key concepts.
And they failed miserably: only got 55% correct,
only about 20% more than they would have gotten just randomly guessing.
If doctors don't understand health statistics,
how can they possibly counsel patients properly?
There was a famous study in which a hundred physicians were asked
what the chances were of a woman actually having breast cancer
if her mammogram came back positive.
They gave them all the numbers so they could do the math,
and 95 out of 100 not only got it wrong,
but spectacularly wrong: off by a thousand percent.
Even doctors at Harvard had a problem.
Faculty, staff, and students at Harvard Medical School
were asked a simple question, and 82% got it wrong.
That was a few decades ago, though.
In an updated survey in Boston, only 77% got it wrong,
an average of about 3000% off,
demonstrating medicine's continued discomfort with math.
Only 12% of thousands of OB-GYN residents were able
to correctly answer two simple questions on medical statistics.
"What will the uninformed 88% of these residents say
when their first patient asks about her chance of truly having breast cancer
given a positive mammogram?"
And what's particularly frightening is that in some studies,
those doctors "most confident in their estimates were furthest away from
the correct response," so they didn't even know that they didn't know.
"All these studies document the same phenomenon:
a considerable number of physicians are statistically illiterate,
that is, they do not understand the statistics of their own discipline."
So when physicians say they don't have time to fully inform patients
about the benefits and harms of a test, maybe that's a good thing,
if they don't know what they're talking about.
Instead they may just talk about the benefits and skip the whole harms part.
And so we shouldn't be surprised when 9 out of 10 women say,
"Harms from mammograms? What harms?"
while often greatly overestimating the benefits,
whereas, in fact, the benefits and harms may be so evenly balanced
that maybe we should just inform women and let them make up their own minds.
But that's not what you hear from ad campaigns.
They just tell women to do it, overstating the benefits,
sometimes ignoring harms altogether,
using persuasion instead of education— fear, guilt, whatever it takes.
It's easy to "sell" screening: just magnify the benefit,
minimize the harms, keep the actual numbers under wraps.
I mean studies have randomized hundreds of thousands of women
to get mammograms or not to put it to the test.
What's the point if we're not going to share the results?
We spend billions on these clinical studies but fail to ensure that
patients and physicians are communicated the results in a transparent manner.
Maybe women should tear up the pink ribbon
and campaign for honest information.
How else can women make informed decisions?
Instead, we get hospitals putting on like mammogram parties.
Maybe in addition to the appetizers,
they should serve women balanced information to chew on as well.