Amplifying a confused breast cancer message doesn’t really help anyone

Whatever you believe about the correct age to start mammograms, last week’s release of revised breast cancer screening guidelines from the US Preventive Services Task Force was an example of a poor communication strategy — and resulting confusion and backlash.

Thanks to the efforts of Susan G. Komen for the Cure and other cancer advocacy groups, communication heretofore has been clear, that breast cancer is a risk for all women and that mammograms are advised for screening, generally beginning at age 40.

The Task Force acknowledged mammography’s effectiveness but also its less accurate results for women under 50 than for women older than 50. The group went on to challenge the widely-established start time for annual mammograms of age 40, recommending that most women of lower risk (without family history) to start screenings at age 50 – and even then only every other year, rather than annually.

The Task Force, an independent panel of experts in primary care and prevention from some of the nation’s leading universities, teaching hospitals and research institutions, is appointed by the U.S. Department of Health and Human Services. Many people reacted to the recommendations with distrust of in light of the coincidental timing with the current healthcare debate. Could this be a harbinger of healthcare rationing to come?

The controversy seems not so much a conspiracy of timing as an unfortunate lack of coordination of message strategy on an important health issue. The Task Force members looked at the best data currently available to draw their conclusions. What they didn’t do was talk to health advocacy groups such as Susan G. Komen for the Cure and American Cancer Society to come up with a coordinated strategy to communicate the findings in the context of what the cancer groups have been propounding for decades.

If they had, perhaps the results could have been better explained as based on the data that for every approximately 1,900 mammograms for women 40 to 49, one breast cancer is discovered – along with many more false positives that for women 50 to 59. For the older group, the rate of cancers discovered is approximately one in every 1,300 mammograms.

Perhaps if discussion had occurred in advance, the call for further research into better screening, causes and cures for breast cancer could have been better articulated. Breast cancer remains the most common cancer among women except skin cancer and the second-highest cause of cancer death, after lung cancer. Death rates from breast cancer have been declining since about 1990, with larger decreases in women younger than 50. “These decreases are believed to be the result of earlier detection through screening and increased awareness, as well as improved treatment,” according to the American Cancer Society’s website.

It’s clear that the price of maintaining those decreases and who and how to pay for them will be a part of any future presentation of new screening recommendations. When we can so effectively save lives with early detection, it’s worth further discussion. Bring on the discussion, include all of the players and maybe next time the communication will be more effective.