In a 2012 Breast Cancer Consortium research brief, we highlighted an article in the “not so” column of the British Medical Journal (published August 12th). The column is an occasional series highlighting the exaggerations, distortions, and selective reporting that make some news stories, advertising, and medical journal articles. In it, professors Lisa M. Schwartz MD and Steven Woloshin MD, of the Department of Veterans Affairs Medical Center and the Dartmouth Institute for Health Policy and Clinical Practice, explained that Susan G. Komen for the Cure had exaggerated and distorted medical information to persuade women to get mammograms.
To recap, “How a charity oversells mammography“ pointed out two serious flaws in Komen’s 2011 breast cancer awareness campaign. See an advertisement from the campaign below. Instead of mammography screening being “the key” to surviving breast cancer as the advertisement says, evidence shows that screening may reduce a woman’s chance of dying from breast cancer by a very small amount (0.07 percent for a woman over age 50). And, instead of suggesting that high five-year survival statistics (98% in this advertisement) are evidence that “early detection [through mammography screening] saves lives,” Schwartz writes, “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.” The reason is that it is impossible to separate “lead time” (the time difference between when a cancer can be diagnosed with screening and when it can be felt) from “overdiagnosis” (when cancers are detected that never would have been life threatening or caused symptoms in a persons lifetime.) In this context, there is no correlation between survival statistics and how many people die.
In addition to the misuse of statistics, Woloshin and Schwartz noted that the advertisement ignored the harms of screening, including false alarms, unnecessary testing, and the greater chance of being treated with surgery, chemotherapy, or radiation without actually benefitting from those treatments. While Komen may acknowledge these complexities elsewhere, the soundbites echo throughout the organization’s campaigns and informational materials.
After the story came out, a Komen spokesman defended the campaign statements. In a Fox News interview, Komen vice president Chandini Portteus said, “The numbers are not in question. Early detection allows for early treatment, which gives women the best chance of surviving surviving breast cancer. She echoed the statement to ABC news, calling screenings “the best widely available detection tool that we have today.” Unfortunately, neither of these statements address the criticisms. The numbers ARE in question, which was the point of the BMJ article.
Woloshin and Schwartz are not the only researchers concerned about the “wishful conviction” surrounding mammograms. Dr. David Newman MD summed up a major review of the data from numerous trials of mammography. After randomly assigning nearly 600,000 women to undergo either regular mammography screening or no screening, and following those women for more than a decade, the women in the mammogram group were just as likely to die as women in the no-mammogram group. The women having mammograms were more likely to be treated for cancer and have surgeries like a mastectomy. So while some of the most staunch critics of overselling mammography are clear that they want women to have balanced information about its benefits and harms to make informed choices, they are not trying to stop women from getting screened or insurance companies from covering screening. Unfortunately the nuance and complexity surrounding routine screening gets lost amid the fear of breast cancer and repeated advertisements that simply tell women what to do.
In the months since the uproar about Komen’s science denialism, the organization started to remove evidence of the “Get Screened Now” campaign. The URL in the advertisement komen.org/getscreened (below) vanished from the website and now points to the default home page.
A related “Promise-Action” page (below), no longer links to the primary website. It does come up in a list if you enter “promise-action” in the Komen search box. http://ww5.komen.org/promise-action.html
As Komen’s bold messaging continues to be erased from its materials if not from collective memory, is it enough for the group to simply step back and quietly disassociate from a misinformed pro-mammogram campaign? Especially when there is such strong evidence that “screening mammograms aren’t all they’ve been cracked up to be?”
Komen has been so successful in spreading the message that mammograms are the key to surviving breast cancer that without an equally strong campaign to clarify the overstatement, misinformation about mammograms will continue to abound within the Komen empire and beyond. This is just a shortlist of Komen materials still using the same messaging.
- “Early Detection Research Saves” - Komen Early Detection Fact Sheet (2013)
- “Fact Three: You can have tests that find breast cancer early.” - Komen Breast Health: Learn the Facts (2013)
- “Remember, even if you feel healthy now, just being a woman and getting older puts you at risk for breast cancer. Getting checked regularly can put your mind at ease. Finding cancer early may save your life.” - Komen Facts for Life: Breast Cancer Detection (2013)
- “Have a mammogram every year starting at age 40 if you are at average risk.” - Komen Educational materials (2013)
- “Early detection of breast cancer saves lives and thousands of Orange County women.” - Komen Orange County (2012)
- “Komen Austin was able to fund over 3,000 mammograms. I think of that as 3,000 lives saved.” - Komen Austin (2012)
- “Take charge of your health and sign up to receive a mammogram and/or clinical breast exam reminder.” Komen website (2013)
- “Getting regular screening tests is the best way to lower your risk of dying from breast cancer. Screening tests can find breast cancer early, when it’s most treatable.” Komen website (2013)
- “Five-year relative survival rates for women with early stage cancers (before they’ve left the breast) are at 99% (up from 74%when we started).” - Komen founder, Nancy Brinker (2013)
- “Our position at Susan G. Komen and that of most major cancer and medical associations has been clear for years: The best offense against breast cancer is early detection coupled with timely and effective treatment. We have 98 percent five-year survival rates for breast cancers caught early, before they spread beyond the breast. That five-year survival rate falls to 23 percent when breast cancer is diagnosed at the latest stages. This is why we continue to recommend annual mammograms beginning at 40 for women of average risk, and why we emphasize the importance of good communication with health care providers.” Komen founder, Nancy Brinker (2011)
Komen’s position that regular screening is the ticket to saving lives will be a hard habit to break. After all, mammography has been the rallying cry for breast cancer awareness for decades. And, it has helped to build an economy that focuses not on primary prevention but on the management of risk. It’s hard to think about the complexities of breast cancer when pink ribbon imagery and awareness campaigns tell you that doing so is just a waste of energy.