August 3, 2012
Doctors Criticize Breast Cancer Charity For Misleading Women
Lawrence LeBlond for redOrbit.com - Your Universe Online
The nation´s largest breast cancer charity -- Susan G. Komen for the Cure -- is being criticized by doctors who say the group´s misleading statistics are convincing women to have mammograms and failing to alert them on the risks.
In a paper published in the British Medical Journal, Steven Woloshin and Lisa Schwartz of the Dartmouth Institute for Health Policy and Clinical Practice in Hanover, NH are accusing the charity of overstating the benefits of mammography and ignoring the risks involved with the procedure in its latest ad campaign.
In the latest ad, Komen for the Cure urged women should get regular mammograms and in a roundabout way said that skipping them was harmful to their health. The ad claims, according to the BMJ paper, “early detection saves lives. The five-year survival rate for breast cancer when caught early is 98 percent. When it's not? 23 percent.”
Woloshin and Schwartz wrote in the journal that the actual advantages of mammography are much less clear and women should be told about the positive and negative associated with breast cancer screening.
Breast cancer screening programs have come under fire in recent years as studies have shown that they can identify tumors that may never cause any harm, and often lead to medical procedures that lead to physical, emotional and financial woes.
The US Preventive Service Task Force stirred up the controversy when, in 2009, it made recommendations to limit mammograms at younger ages for women. It also pushed to eliminate PSA testing for prostate cancer in men, which led to numerous studies and reports on the pros and cons of cancer screening.
A growing body of evidence shows that although screening may reduce a woman´s risk of dying from breast cancer by a small amount, the negative risks associated lead most experts to shun the controversial test at younger ages.
The percentage differences shown in the latest Komen ad look so big that it would be hard to imagine why any woman would forego cancer screening. But the authors explain that comparing survival between screened and unscreened women is “hopelessly biased.”
“To make an informed decision, you not only have to know the benefits you have to know the harm. And the ad does not say anything about harm, it just gives you this exaggerated benefit statistic,” Woloshin said.
“We think Komen can do a lot better by giving women the information they need to weigh the benefits and the harms,” Woloshin told Michelle Fay Cortez of Business Week in a telephone interview. “They aren´t doing a good job. The ads are misleading and give false promises.”
The study authors said the actual benefit of mammography is much less significant. It may reduce the chance that a woman in her 50s will die from breast cancer over the next ten years from 0.53 percent to 0.46 percent, a minute difference of 0.07 percentage points, they wrote.
According to the American Cancer Society, breast cancer killed an estimated 40,000 women in 2011 and is the second-leading cause of death among women.
But for every woman whose life is saved because of screening, two to 10 other women are diagnosed unnecessarily and treated with drugs that give them no benefit, Woloshin said.
“Screening is a genuine decision people need to make and they can only make it if they have the facts. It doesn't mean that screening is not good, it means it does good and it does harm. Some people can benefit and some will get hurt, and the harm is just as real as the benefit,” he explained.
But Komen said while mammography isn´t perfect, it is the best detection tool available for breast cancer screening.
“We have long advocated for women to be informed about the benefits and risks of early detection and treatment,” said Chandini Portteus, Komen's vice president of research, evaluation and scientific programs. “The numbers are not in question. Early detection allows for early treatment, which gives women the best chance of surviving breast cancer.”
Since its foundation in 1982, the Komen organization has invested nearly $2 billion in breast cancer research. “We've said for years that science has to do better, which is why Komen is putting millions of dollars into research to detect breast cancer before symptoms start -- through biomarkers, for example,” added Portteus.
“Komen also is funding research to help accurately predict which tumors will spread and which won't. 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,” she said.
Portteus said Komen encourages women to work with their health care providers to find out what's right for them.
But Woloshin and Schwartz suggest that even doctors may not know what´s best for their patients. In their recent survey they found that doctors have mistook improved survival as proof that screening saves lives.
“The survival statistics are confusing for doctors, too,” wrote Woloshin. “This is a real communication problem that doctors and patients alike face, so whenever you hear about survival statistics in the context of screening, you should ignore them. The only way to know if a screening test works is if it is proven in a randomized trial that shows that less people die because of screening.”
“Women need much more than marketing slogans about screening: they need - and deserve - the facts,” wrote 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.”
Dr. Stephanie Bernik, chief of surgical oncology at Lenox Hill Hospital in New York, disagrees.
“The Komen foundation is doing nothing new by presenting data that supports their position in a favorable light. Although there is controversy regarding the absolute benefit of mammography screening in many studies, most breast surgeons stand behind the Komen foundation's stance that screening mammography saves lives,” Bernik told CNN´s Sandra Young. “We all agree that screening increases the number of procedures that are performed, but finding a tumor at an earlier stage cannot be worse than finding it when it is larger.”