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Missing The Point: Various Representations Of The Same Study

A paper presented at the 2011 American Society of Clinical Oncology (ASCO) breast cancer symposium this week has drawn all kinds of news coverage – and much of it is off the mark – even in the eyes of one of the American Cancer Society’s top docs.

The paper concluded:

“Results of this study validate the importance of annual screening mammography in women older than 50 years, and women aged 40 to 49 years recently omitted from screening guidelines. There was an increased prevalence of palpation (breast self exams) for the method of detection in women less than 50 years of age. If screening mammography is omitted in this group, cancers when detected may be of a more advanced stage and result in more mastectomies. This study also supports the use of palpation as a method of detection despite recent recommendations against teaching self breast exams by the USPSTF (US Preventive Services Task Force).”

WebMD’s lead sentence was:

“Once again, researchers are questioning the wisdom of guidelines that do not recommend annual mammograms for women aged 40-49 who are at average risk of breast cancer.”

HealthDay led with:

“Contrary to some other findings, new research indicates that mammograms and breast self-exams are useful for the detection of breast cancer, including cancers in younger women.”

Not so fast.

Dr. Len Lichtenfeld, deputy chief medical officer of the American Cancer Society, posted a very thoughtful analysis on his blog. Excerpt:

“You might imagine that-as an advocate of breast cancer screening and the value of early detection – I would be dancing in the streets as a result of this report.

Sadly, I am not.

In fact, if anything, I am concerned that the various representations of this study that I have read missed a fundamental point: this study reports information, but is not designed to answer the questions which the headlines and the press release suggest as the appropriate conclusions, namely that mammography and breast self-examination in women between the ages of 40-49 saves lives.

Past research studies have not shown that a formal, monthly program of breast self-examination saves lives, and this study wasn’t designed to show that it does. Both the American Cancer Society and the USPSTF agree on this point.

despite my bias in favor of screening – I don’t think it is wise to draw sweeping generalizations for the public based on a limited set of information that on close inspection does not support the conclusions that some have suggested.”

I can’t do justice to Dr. Lichtenfeld’s post without re-posting the entire column. Instead, I encourage you to visit his blog and read it all there.

*This blog post was originally published at Gary Schwitzer's HealthNewsReview Blog*


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