Susan G. Komen's emphasis on mammograms during breast cancer awareness month called into question
In a commentary published in the British Medical Journal (BMJ) called "How a charity oversells mammography," two professors at Dartmouth Medical School say breast cancer awareness month, "otherwise known as 'October'" is the most prominent of the 175 officially designated national health observances in the United States.
"Like U.S. Independence Day, Thanksgiving, and Christmas, disease awareness has made it into the US calendar," the authors wrote. "And no organization has done more to promote this observance than Susan G Komen for the Cure, the world's largest breast cancer charity and creator of the ubiquitous "pink ribbon," which each year aims to "turn the country pink for national breast cancer awareness month."
Breast cancer awareness month is so prominent that buildings around the world are tinted pink and the National Football League encourages its players and personnel to wear pink for every game in October.
Dr. Lisa M. Schwartz and Dr. Steve Woloshin, both professors of medicine at the Geisel School of Medicine at Dartmouth in Hanover, N.H., however say that Komen's campaign is best known for promoting mammography screening despite its unclear benefits.
"Unfortunately, there is a big mismatch between the strength of evidence in support of screening and the strength of Komen's advocacy for it," they wrote.
The authors write that the benefits and harms are so evenly balanced that a major U.S. network of patient and professional groups, the National Breast Cancer Coalition, says there is insufficient evidence to recommend for or against universal mammography for women of any age group.
Mammography's benefits have been an oft-debated topic since 2009, when the group of medical advisors who recommended government treatment guidelines, the U.S. Preventive Services Task Force, advised against the scans for women in their 40s said those in their 50s should only get one every other year. The group said the benefits of screening women in their 40s did not outweigh the risks from unnecessary treatments.
While controversial at the time, some research since has supported the task force's findings.
An April study found mammograms may lead to breast cancer overdiagnosis, and estimated 15 to 25 percent of cancers found by mammograms would not have caused a problem during a woman's lifetime. However those women were often treated with surgical procedures, radiation or chemotherapy, the researchers said.
A study last October found more than half of women who start getting annual mammograms in their 40s can expect to have a false positive test, 7 percent of whom will be advised to undergo a biopsy that will turn out to be negative.
Some research however has found life-saving benefits from mammograms, including a 2011 study that tracked 133,000 women for up to three decades and found women who were routinely screened with mammograms were 30 percent less likely to die from breast cancer.
Another recent study found that the benefits of screening women in their 40s every other year for breast cancer would statistically outweigh the risks associated with treatments.
The American Cancer Society says mammograms are not perfect at finding breast cancer and don't work as well in younger women.
However Susan G. Komen's breast cancer awareness advertisements only state the benefits of mammography when telling women to get screened and give "women no sense that screening is a close call," the authors argued.
One ad in particular they flagged stated, "What's the key to surviving breast cancer? You" and went on to say the five-year survival rate for breast cancer caught early is 98 percent, compared with only 23 percent survival when it is not.
However the authors call that comparison in survival rates between screened and unscreened women "hopelessly biased." They explain that overdiagnosing cancers that are too slow-growing to ever cause a problem may skew survival statistics, because the women would have survived anyway after 5 years regardless of a mammogram.
In terms of actual benefit, the authors say mammograms can reduce the chances a woman in her 50s dies of breast cancer over the next 10 years from 0.53 percent to 0.46 percent, a difference of 0.07 percentage points - not the 75 percentage point-difference the ad touts.
"If there were an Oscar for misleading statistics, using survival statistics to judge the benefit of screening would win a lifetime achievement award hands down," they write.
The researchers say for every life saved by mammography, about two to 10 women are overdiagnosed.
"Women need much more than marketing slogans about screening: they need - and deserve - the facts," conclude the authors. "The Komen advertisement campaign failed to provide the facts. Worse, it undermined decision making by misusing statistics to generate false hope about the benefit of mammography screening. That kind of behavior is not very charitable."
Susan G. Komen defended its campaign.
"Everyone agrees that mammography isn't perfect, but it's the best widely available detection tool that we have today," Chandini Portteus, Komen's vice president of research, evaluation and scientific programs, told HealthDay. She added that the organization was funding millions of dollars worth of research on finding other ways to detect breast cancer early before symptoms appear. "While we invest in getting those answers, we think it's simply irresponsible to effectively discourage women from taking steps to know what's going on with their health," Portteus said.
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