Outside Voices: Andrew Holtz Wonders Whether We're Getting All The Health Care Information We Need

(Courtesy Andrew Holtz)
Each week we invite someone from outside PE to weigh in with their thoughts about CBS News and the media at large. This week, we turned to Andrew Holtz, MPH, a former CNN medical correspondent and author of the book The Medical Science of House, M.D. Holtz is also the past president of the Association of Health Care Journalists and currently sits on its board. The opinions he expresses here are not necessarily those of AHCJ. Below, Holtz wonders if we're getting all the news we need to make informed decisions about health care. As always, the opinions expressed and factual assertions made in "Outside Voices" are those of the author, not ours, and we seek a wide variety of voices.

A recent international report had some good news about mammography… and some not so good news. The systematic review of clinical trials concluded women who get mammograms are less likely to die of breast cancer. However, for each life saved, 10 women may be treated unnecessarily for cancers that are not dangerous to their health.

Did you know that?

Probably not, if you get your news from CBS, because the network apparently didn't think the report was news at all. I'm picking on CBS only because this is the CBS Public Eye Web site; none of the major U.S. news organizations reported on the study that concluded routine mammography screening may be 10 times as likely to lead to unnecessary treatment as it is to save a life.

I'm not saying mammography is bad. In response to the latest study, a number of cancer experts rose to defend recommendations that most women start getting regular mammograms in middle age.

Actually, I'm not writing about mammography at all. My question is: are we getting the sort of information in news stories that will help us make informed decisions about widely-used medical tests and treatments?

Are you interested in getting the big picture on mammography … the imperfections and limitations … as well as the benefits? Apparently, news editors at CBS and other U.S. news organizations didn't think you'd be very interested in the systematic review of randomized clinical trials of mammography screening that was released in October by a prestigious international collaboration of medical researchers.

News editors in Britain and other countries made very different judgments.

The BBC reported that "Concerns have been raised that breast cancer screening might lead to some women undergoing unnecessary treatment." The story went on to note that researchers "found that for every 2,000 women screened over a decade, one will have her life prolonged, but 10 will have to undergo unnecessary treatment."

And a story on the British Guardian newspaper's web site had this lead: "Research published today suggests women should be better informed of the harms of breast cancer screening, including the increased likelihood of having a mastectomy and receiving radiotherapy."

The report published by the international Cochrane Collaboration did receive criticism, in part because the first author, Peter Gøtzsche, M.D. in Copenhagen, has long been skeptical of the overall value of routine mammography. We are usually led to believe that controversy and conflict enhance the news value of a story, and the British broadcast and newspaper reports highlighted the conflict among experts, but this fresh salvo in the mammography debate didn't catch the eye of most U.S. news editors.

So why wasn't the report seen as a story on this side of the Atlantic? Are U.S. breasts somehow different than those in the U.K.? Not likely.

Were CBS editors unaware of the report? I doubt it. The e-mailed summary that alerted me was also sent to more than 800 other journalists around the country … and the stories done by British, Canadian, Australian and other journalists were carried by wire services and posted on the Internet. In fact, Lisa Esposito of the Health Behavior News Service says the study summary was sent to five people at CBS News. Esposito says they expected a big response to the study, but didn't get it.

Do CBS news editors think breast cancer stories are uninteresting? It doesn't seem so. Just two weeks before this mammography report was issued, the CBS "Early Show" ran a special three-part series on breast cancer awareness. October was "National Breast Cancer Awareness Month," after all.

A year earlier, the breast cancer month headline on the "Early Show" was "New Evidence Backs Mammogram Use." The story, as posted on CBSNews.com, led with, "The latest numbers show routine mammograms are an essential weapon in the battle against the deadly disease, according to The Early Show medical correspondent, Dr. Emily Senay."

In her story this October, Dr. Senay noted that there has been controversy about when women should start routine screening with mammography, but then she said, "Fortunately most experts are in agreement that women 40 and older should get a mammogram once a year." Dr. Senay underlined the potential benefits of mammography, but did not mention that some women may receive unnecessary treatment after a mammogram, including surgery, radiation, and chemotherapy. Now maybe that toll is just the inevitable price of using imperfect tests in an effort to save lives … but shouldn't the balance of pros and cons be included in the story?

And by the way, while the American Cancer Society and some other groups do recommend mammography every year or two for women beginning at age 40, other groups and the health agencies of most other countries say the strongest evidence points to a net benefit from mammography only among women 50 and older.

I asked some fellow journalists for their thoughts on why U.S. news organizations didn't do stories about the recent Cochrane review. One said she had pitched stories about both the benefits and risks of mammography to several magazines without success. A writer who is also a physician said that mammograms save lives and so we don't want to discourage women from getting them.

Journalists are supposed to be watchdogs, with a special duty to scrutinize orthodox opinions. But it seems that skeptical eye becomes clouded when reporters and editors have to deal with certain health topics, including cancer screening tests such as mammography.

A "don't rock the boat" attitude has consequences. Last spring, researchers at the University of Michigan announced the results of a survey of women who were waiting for a mammogram. The women tended to think that their risk of breast cancer was far higher than it actually was … but also that mammography offered far more protection than it really does.

When asked whether "mammograms detect all breast cancers," almost a third of the women agreed with, or were neutral about, the statement. The researchers concluded that "expectations about the performance of mammography were abnormally high or unrealistic."

How much of the misunderstanding of mammography is due to an overabundance of stories touting benefits, including saving some lives, and a corresponding lack of coverage about the imperfections of breast cancer screening, including the number of women given unnecessary treatment?

One of the researchers who surveyed women getting mammograms said the limitations of mammography are not well publicized. She pointed to other studies linking media reports to unrealistic fears of breast cancer and unsupported confidence in mammography.

Another radiologist has called for a different type of awareness campaign. Dr. Leonard Berlin has urged in a recent medical journal article that various radiology groups and "the American Cancer Society should consider undertaking efforts that would educate the public to the fact that mammography may not be as accurate as initially thought, that early diagnosis of breast cancer does not necessarily guarantee a cure, and that failure to diagnose breast cancer earlier does not necessarily result in a poorer prognosis."

Let me stress, I am not arguing women should ignore the advice of their physicians and other health experts about cancer screening. But I do think women deserve to have all the important facts, favorable and unfavorable, about both benefits and harms, so that when they walk into the mammography room, they understand what the test offers and, just as importantly, what it cannot promise.

The recent systematic review of mammography benefits and harms would have provided a good news hook for that sort of story, but the opportunity to dispel myths and misunderstandings passed almost unnoticed in this country.

While the BBC and other British news outlets ran headlines in October such as "Breast Screening Concerns Raised" and "Researchers question benefits of breast cancer screening," U.S. women saw story after story on breast cancer that never mentioned the potential downsides of mammography ... with rah-rah leads such as "Mammograms are good" and " No more excuses for not getting mammograms."

It seems British editors have a different view from those in the U.S., including those at CBS News, about what sort of information is relevant to their readers and viewers.

Don't you want the whole story of mammography, warts and all?