Tag Archives: mammograms

Covering news about screenings, preventive health recommendations

Pia Christensen

About Pia Christensen

Pia Christensen (@AHCJ_Pia) is the managing editor/online services for AHCJ. She manages the content and development of healthjournalism.org, coordinates AHCJ's social media efforts and edits and manages production of association guides, programs and newsletters.

AHCJ webcastThe U.S. Preventive Services Task Force just released a recommendation that pregnant women be screened for gestational diabetes, even if they have not been previously diagnosed with type 1 or 2 diabetes.

The task force often finds itself in the news when determining what works and doesn’t work in screenings and preventive care.

Previously, it told healthy women not to bother with calcium and vitamin D pills, said many women could wait on mammograms until age 50 and recently clarified who might benefit from regular lung cancer screening tests. The task force’s work lies in translating medical evidence into clinical practice, which can be a difficult and contentious task. Its recommendations are often nuanced and misunderstood.

How does the group come to these determinations and how can you report on the science and not just the heat a recommendation generates? What is evidence-based medicine and how does the USPSTF use it to make recommendations on health care services?

In a Jan. 28 webcast, USPSTF chair Dr. Virginia Moyer and co-vice chair Dr. Michael LeFevre will explain how the task force works in an effort to deepen our reporting of upcoming task force recommendations. A Q&A with the doctors, moderated by AHCJ medical studies topic leader Brenda Goodman, will follow. Continue reading

Breast cancer screening recommendations up for review

Brenda Goodman

About Brenda Goodman

Brenda Goodman (@GoodmanBrenda), an Atlanta-based freelancer, is AHCJ’s topic leader on medical studies, curating related material at healthjournalism.org. She welcomes questions and suggestions on medical study resources and tip sheets at brenda@healthjournalism.org.

With mammograms in the news lately, it’s worth noting that the U.S. Preventive Services Task Force has posted its plan for reviewing and updating its recommendations for screening for breast cancer. The draft research plan lays out the “strategy the Task Force will use to collect and examine research and is the first step in updating the 2009 recommendation,” according to Ana Fullmer at USPTF. Recommendations are updated every five to seven years, so she says a new recommendation probably won’t be finished for a few years.

The panel is seeking answers about the specific benefits and harms of screening mammography for women over 40, they’re asking if benefits and risks vary by imaging technique – digital mammograms, ultrasound or MRIs; and importantly, they’re trying to find out how common ductal carcinoma in situ (DCIS) is in the U.S. and what benefits and harms are involved in treating it.

Experts recently recommended renaming DCIS to exclude the word “carcinoma” so the finding wouldn’t be so frightening to patients. DCIS is an abnormal pattern of cell growth in the milk ducts of the breast. In many cases, it doesn’t progress to cancer. Yet a growing number of women have decided to remove both breasts rather than take their chances that it isn’t dangerous.

Interested parties who want to weigh in on the draft plan are encouraged to submit comments and questions to the Task Force by Dec. 11.

Navratilova, GMA uncritically push screening

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism.

In February, Martina Navratilova was diagnosed with ductal carcinoma in situ, the most common form of breast cancer. She has since had a lumpectomy and says she’s doing well and doesn’t expect the cancer to return. But in an interview with Good Morning America during which she announced her diagnosis and surgery, the tennis star stepped beyond the world of sport and into the world of medicine. And there she made the sort of missteps she’s known for avoiding on the court.

“The reason I wanted to speak about this is to encourage these woman to have mammograms,” (Navratilova) said. “I just want to encourage women to have that yearly check-up.”

Navratilova said she doesn’t agree with recent recommendations that women between the ages of 40 and 49 should not necessarily get regular breast cancer screenings.

“The cancer knows that you’re not 50 yet?” she said. “I can’t speak for the doctors, but in my personal case I’m so glad that I did it.”

In her blog “A Healthy Piece of My Mind,” writer and PR rep Eve Harris pointed out the fallacies lurking in the tennis star’s screening recommendations, beyond the obvious age-related concerns.

First, Harris said, Navratilova exhorts women to scrape together the money to pay for screenings, yet doesn’t mention the many programs available to help uninsured and underinsured women pay for mammograms.

Second, Navratilova claims that she was lucky, and would have been in serious trouble had she not detected the cancer when she did. In fact, Harris writes, there is not enough information about the natural progression of such cancers to make that declaration.

GMA correspondent Robin Roberts, who also has battled breast cancer, failed to point out any of that and, in fact, offered a very simplified interpretation of what the new breast cancer screening recommendations say.

(Hat tip to @lauranewmanny)

AP story focuses on overuse of medical treatments

Pia Christensen

About Pia Christensen

Pia Christensen (@AHCJ_Pia) is the managing editor/online services for AHCJ. She manages the content and development of healthjournalism.org, coordinates AHCJ's social media efforts and edits and manages production of association guides, programs and newsletters.

Lindsey Tanner of The Associated Press addresses the overtesting and overtreatment that have become the focus of several studies and journal articles.

Tanner points to President Obama’s recent medical checkup, during which he had a prostate cancer screening and a virtual colonoscopy – neither of which is normally recommended for patients his age.

Increasingly, experts are questioning whether doctors are practicing “defensive medicine” – ordering tests and treatments to be sure they have covered all the bases even if they are not indicated. Other factors, such as a fee-for-service system and patients who insist on testing and treatments, also come into play.

This week alone, a New England Journal of Medicine study suggested that too many patients are getting angiograms — invasive imaging tests for heart disease — who don’t really need them; and specialists convened by the National Institutes of Health said doctors are too often demanding repeat cesarean deliveries for pregnant women after a first C-section.

Last week, the American Cancer Society cast more doubt on routine PSA tests for prostate cancer. And a few months ago, other groups recommended against routine mammograms for women in their 40s, and for fewer Pap tests looking for cervical cancer.

The focus on overtesting and overtreatment comes the same week CBS News sent out a press release announcing that Early Show anchor Harry Smith underwent a colonoscopy on live television, reported on by Katie Couric. The press release proclaims:

Following Couric’s on-air colonoscopy in 2000, University of Michigan researchers documented a 20% increase in the number of colonoscopies performed across the country, dubbing it “The Couric Effect.”

(Hat tip to Gary Schwitzer)

Prof: Mammogram debate is data vs. anecdotes

Pia Christensen

About Pia Christensen

Pia Christensen (@AHCJ_Pia) is the managing editor/online services for AHCJ. She manages the content and development of healthjournalism.org, coordinates AHCJ's social media efforts and edits and manages production of association guides, programs and newsletters.

When it comes to the recent news that a government task force opposes routine mammograms for women under 50, the public must balance research with anecdotal evidence, according to a professor who studies how breast cancer is portrayed in the media.

Cynthia Ryan, Ph.D., an associate professor of English at the University of Alabama at Birmingham, says the media is doing a “decent” job of covering the debate between the new guidelines from the U.S. Preventive Services Task Force and individuals who are advising that women continue to start having mammograms at age 40.

The professor, who has a book coming out about “the rhetoric of breast cancer in popular women’s magazines,” explains why consumers are torn:

Ryan says that when confronted with extreme representations, there is a part of the human brain that wants to go with scientific study “because we figure it must be credible and rational,” she says. “But another part of our brain embraces anecdotal advice that links the message with a face.

Cancer society’s messages on screening conflict

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism.

The New York Times‘ Gina Kolata reports that the American Cancer Society, a longtime defender of early detection and cancer screening, is planning to release an online message next year “to emphasize that screening for breast and prostate cancer and certain other cancers can come with a real risk of overtreating many small cancers while missing cancers that are deadly.”

MRI
MRI entrance, photo by Scott & White Healthcare via Flickr.

“We don’t want people to panic,” said Dr. Otis Brawley, chief medical officer of the cancer society. “But I’m admitting that American medicine has overpromised when it comes to screening. The advantages to screening have been exaggerated.”

The ACS’ change of heart on breast and prostate screening was inspired, in part, by a recent analysis published in JAMA.

In it, researchers report a 40 percent increase in breast cancer diagnoses and a near doubling of early stage cancers, but just a 10 percent decline in cancers that have spread beyond the breast to the lymph nodes or elsewhere in the body. With prostate cancer, the situation is similar, the researchers report.

In an interesting side note, Kolata includes a quote from Colin Begg, a biostatistician at Memorial Sloan-Kettering Cancer Center in New York, that shows a different perspective on media coverage of the screening debate.

“I am concerned that the complex view of a changing landscape will be distilled by the public into yet another ‘screening does not work’ headline,” Begg said. “The fact that population screening is no panacea does not mean that it is useless,” he added.

Kolata’s story was published on Tuesday. On Wednesday, the ACS released a statement from Brawley in which he says the organization stands by its screening recommendations. In the statement, Brawley says ACS “stands by its recommendation that women age 40 and over should receive annual mammography” and that its recommendation that men consult with their doctors to “make an informed decision about whether or not prostate cancer early detection testing is right for them. ”

The LA Times‘ Booster Shots blog has more, as does NPR’s health blog.