Miscommunicating the Mammography Message (Part 1)

A new public opinion poll out today shows a backlash among American women against controversial new breast cancer screening recommendations. Three-fourths of those participating in the USA TODAY/Gallup Poll said they disagree with the experts' advice and even more younger women said they will disregard it.

mammogram.JPGThe cacophony of angry, confused, accusatory reactions continues to drown out the fundamental message that a prestigious science advisory panel unsuccessfully attempted to deliver last week: namely that individualized, informed decision-making should replace blanket guidelines for universal, routine mammography screening of women in their 40s.

"I really think that mammography screening should not be one size fits all. We need to personalize the decision for each woman," said Dr. Karla Kerlikowske, a primary care physician and mammography-screening expert at the University of California, San Francisco, whom I talked with yesterday. Women at higher risk of breast cancer might be counseled to start screening mammograms in their 40s, while those at lower or average risk generally would not.

The intention of the U.S. Preventive Services Task Force was to widen the choices available to a woman under 50 in terms of mammogram timing and frequency, helping her better understand and decide based on the full range of testing benefits and risks in the context of her overall health. Instead, its poorly delivered message was unfortunately--and I think unfairly--perceived by some as a cost-cutting smokescreen that could limit women's choices and potentially risk their lives.

Similarly, although there was strong consensus in support of regular mammogram screening in women ages 50 to 74, the reasoning behind the panel's recommendation that testing be done every two years was widely misunderstood. The decision came down to every two years, instead of annually, in order to maximize benefits and reduce unnecessary harms to those at average risk.

The blame lies squarely in the hands of the government-appointed medical and public health experts who missed a major opportunity to translate their important findings into useful, easily available information that women, and their doctors, could use to make more informed choices (not to mention the media struggling to report the story).

The independent advisory group to the federal Agency for Healthcare Research and Quality carefully sifted through mountains of scientific data, commissioning new statistical models and a sophisticated analysis of the latest studies. But in the end they failed big time in terms of risk-benefit communication to the audience that really mattered--the public.

The new telephone survey of 1,136 women showed that many greatly overestimate their own risk of getting breast cancer, and that most felt the panel based its recommendations on cost, even though cost was explicitly not part of the panel's assignment.

We can all agree that the breast screening announcement suffered from extremely poor timing--and perhaps a tin ear to the hopes and fears of those who wear the powerful pink ribbon that symbolizes the most feared cancer killer of women. The scientists, the government agency that appointed them, and the medical journal that published their findings helped create the public relations catastrophe by failing to better anticipate how negatively the affected constituencies--including millions of American women and their doctors--might react to the news.

Presented by

Cristine Russell is a senior fellow at Harvard Kennedy School of Government and the president of the Council for the Advancement of Science Writing.

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