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.
It's easy to see why women and their supporters quickly rose to the defense of routine screening mammograms for younger women as an important weapon in their impassioned, frustrating fight against breast cancer. Not to mention those who capitalized upon the announcement as an opportunistic partisan sound-bite by connecting it to the country's raging health care reform debate or who derided the conclusions of the expert panel of 9 men and 7 women as sexist. Others suggested the apolitical panel was naïve about the politicized atmosphere in our nation's Capital. Not surprisingly, many in the media quickly played up the controversies rather than really digging into the obscure, difficult-to-understand numbers.
Nonetheless, this communications disaster could potentially have been avoided if the scientific experts had sought advice about how to craft a meaningful public message about a complex public health problem. In doing so, they needed to separate the issue into two distinct categories: 1. The overall population, or societal impact--what does the recommendation mean for the public at large? 2. The individual impact--what does the recommendation mean for the individual consumer? The answers, as is often the case in medicine, are a combination of science, values, and public perception and may differ depending on who is asking the question.