"9 out of 10 Women Misinformed about Mammograms"
“Selling cancer screening can be easy,”
starts an editorial in the Journal of the National Cancer Institute.
"Induce fear by exaggerating risk.
Then, offer hope by exaggerating the benefit of screening.
And, don’t mention harms…”
caused by the screening.
This ploy “is especially easy with cancer—
no diagnosis is more dreaded.
And, we all know the mantra:
early detection is the best protection.
Doubt it, and someone may suggest
you need your head examined.”
And they are not exaggerating….
Screening can lead to important benefits,
but it can also lead to important harms.
And, that’s the big challenge:
“conveying the counterintuitive idea
that screening doesn’t always help—
and can even be harmful.”
Yet, surveys have shown that most people
believe that cancer screening is almost always a good idea,
and few believe harm is even possible.
In patient education materials, passing references to potential harms
may deceptively be buried under a euphoria of benefits.
The cancer screening test that has been
most carefully studied is mammograms.
In the past 50 years, more than 600,000 women
have participated in 10 randomized trials.
Given this extraordinary research effort,
it’s ironic that mammograms continue
to be one of the most contentious issues within the medical community.
There are few things in medicine that invoke more passion
than mammograms,
with both sides, ironically, accusing the media
of being in the opposite camp.
But, this contentiousness is in itself instructive.
I mean, it should tell us something.
For context, a single study involving fewer than 150 men
who were followed for less than 2 years
was sufficient to convince physicians
of the value of treating severe high blood pressure,
because the benefits were just so obvious,
whereas after 10 trials, 600,000 women,
the fact that we’re still debating the merits of mammograms
50 years later suggests that it’s a close call
between the benefits and harms.
But, that’s assuming people are weighing
the pros and cons objectively.
It may be worse than that,
given the multibillion dollar industries involved,
from the mammogram machine manufacturers
to the radiologists that read them.
Several organizations publish contradictory
cancer screening recommendations.
Some say mammograms starting at age 40; others say 50;
some say every year; some say every other year;
and some say women shouldn’t get them routinely at all.
There’s increasing concern that these disagreements
may be arising from both financial
and emotional conflicts of interest.
People can get so invested in their position
that they’ve staked out, that it kind of clouds their judgement.
Reasonable experts agree that the body of evidence
suggests that there is some benefit to mammography.
Although the benefits have almost certainly been exaggerated.
This does not mean that mammograms don’t save lives
or that women shouldn’t get them.
The question is, "do the benefits outweigh the risks?".
That’s a decision each woman has to make for themselves,
but they can’t do that without knowing all the facts.
Women are so bombarded with information about mammograms,
you’d think women would be fairly knowledgeable about it;
yet, nothing is farther from the truth.
Nine out of ten women surveyed
vastly overestimated the benefits or had no idea.
It’s not the women’s fault, though.
They’re obviously being misinformed by the system.
Most American women didn’t even appear to understand
the basic concept of screening,
thinking mammograms somehow help
prevent you from getting breast cancer in the first place.
This raises doubts about how well women are being informed.
Sounds like women are just being told what they should do,
but “without being given the facts
necessary to make informed decisions.”
“As a result of this paternalism and pink ribbon culture,
almost all women have a false impression
of the benefit of mammography screening.”
“Most surprisingly, those who frequently consulted their physicians
and health pamphlets were slightly worse informed”;
so, they were like anti- educated by their doctors.
And, the problem is that these kinds of inaccurate
and exaggerated perceptions
prevent women from making an informed choice.
“Misleading women, whether intentionally or unintentionally,
is a serious issue.
All of those in the business of informing women
about screening should recall that medical systems
are for patients, not the other way around.”
We should not just blindly be selling screening.
We should be giving people the numbers they need
to decide for themselves.
That’s why I created this video series.
The question of whether screening mammography
does more harm than good has the potential
to shake up the state of our medical knowledge
and alter our views of ethical medical practice.
"The stakes are high in this discourse,
because women’s lives hang in the balance.”