November 5, 2019
Gary Schwitzer is founder & publisher of HealthNewsReview.org. He has written many times about breast cancer screening and treatment controversies. He once produced breast cancer decision-making videos for the Foundation for Informed Medical Decision Making, which was the first funder of HealthNewsReview.org from 2005-2013.
Breast Cancer Awareness Month is over for another year. But it’s not too late to reflect on, and learn from, one of the most troublesome breast center marketing ideas in recent memory.
As described in stories all over the globe, including in the Washington Post, the NBC Today Show website, People magazine, Adweek, and Fox News, a TV anchor was convinced by a breast center marketing person to show her first mammogram on Facebook Live.
The woman, Ali Meyer of KFOR-TV in Oklahoma City, said, “I was hoping for a routine little mammogram. That’s not how this went.” The mammogram showed calcifications in her right breast. Surgeons recommended a mastectomy, and she agreed.
Ironically, while it was intended to promote Breast Cancer Awareness Month, the stunt (as the Washington Post called it) showed that awareness efforts – when they become marketing messages – may leave out issues of evidence and decision-making options.
Here is the story that appeared on the reporter’s TV station.
While we wish good health for the reporter, Ali Meyer, we feel compelled – given how much attention this has received – to point out how uninformed the news coverage has been.
What’s missing about her diagnosis & treatment options
- News coverage consistently refer to cancer or a noninvasive form of cancer. Meyer was found to have DCIS, or ductal carcinoma in situ. We’ve written about it a great deal because it is one of the most confusing and miscommunicated diagnoses in medicine. Deanna Attai, MD, is a breast surgeon and past president of the American Society of Breast Surgeons. She wrote to me:
The radiologist found ‘cancerous calcifications’ but calcifications and cancer are not synonymous. Calcifications form in breast cells for many reasons. But the calcium is not the disease. I explain it to patients as a possible red flag.
Cancer or carcinoma implies invasiveness and DCIS is specifically not invasive. Some scientists and medical professionals are calling for removal of ‘carcinoma’ from the name for the disease. Nomenclature was discussed at the National Institute of Health State-of-the-Science Conference: Diagnosis and Management of Ductal Carcinoma. Proponents argued that a name change would be more accurate and would decrease some of the anxiety associated with the diagnosis. In the final report, the Consensus Panel concluded ‘because of the noninvasive nature of DCIS, coupled with its favorable prognosis, strong consideration should be given to removing the anxiety-producing term ‘carcinoma’ from the description of DCIS.
- The Washington Post reported: “The disease had a high survival rate, but she would probably need a mastectomy.” Meyer said she interviewed multiple surgeons who all said she needed mastectomy. But journalists should be wary of framing mastectomy as necessary. Michelle Tregear is director of education and training programs for the NBCC, and also a breast cancer survivor. She wrote me:
Numerous studies have shown widespread screening has resulted in about 30% overdiagnosis. Her case is an example of potential overdiagnosis and subsequent overtreatment. So many women with a diagnosis of DCIS are likely confused about what it actually means and what their risks are and the benefits and risks of various treatment options. What is sad about this is that she is grateful for the removal of her breast. And she may not have needed this to begin with. There was no reporting about the severity of the DCIS, nor the other, less invasive options for treatment for this early stage 0 disease.
- Anchorwoman Meyer stated on the air: “My surgical options, my recovery and my outcome were all better because my mammogram found the cancer before I even knew it was there.” Dr. Attai wrote: “Maybe. Some cases of DCIS do not progress to invasive cancer, but we do not have good ways to identify which women will not need treatment. Certainly if she were one whose disease were destined to progress, her long term outcome and treatment options are better if diagnosed at stage 0 versus stage I – but there is no way to know at this point in time.”
- The Washington Post referred to Meyer as now being cancer-free one year later. And the Post called it a “happy ending.” Dr. Attai points out: “A clear mammogram tells us that there is nothing visible to indicate a problem or raise suspicion. That is not the same as cancer free.” And it may not signal a happy ending. The words matter – and throwing around terms like “cancer-free”, “clear” (recall Alex Trebek’s recent story) and “happy ending” is not good journalism in the absence of contextual reporting.
Medical marketing gone awry
Meyer said in the piece that aired, “This whole thing was her idea.” Her refers to the marketing director for the University of Oklahoma’s Stephenson Cancer Center.
The marketing director said: “I thought this would be easy. No big deal, 30 minutes. I made the appointment for (Meyer). Thought we’d be in and out. …My heart just sunk cuz I never in a million years expected it not just to be a quick and easy story about your first mammogram.”
That statement reflects either incredible naivete or a total lack of understanding of what’s at stake whenever a woman has a mammogram – or both.
But the bigger issue here is journalistic integrity. Michelle Tregear of the National Breast Cancer Coalition (NBCC) wrote to me that it is inappropriate for journalists to participate in such “here I am getting screened” reporter-involvement stories.
Journalists should have a high bar when it comes to health information reporting/dissemination. One of their primary concerns should be in disseminating accurate information. She should have started digging in and asking questions when the cancer center marketing director first reached out to her with this idea. If she had, she would have found that for women like her, with no apparent risk factors, the likelihood of having breast cancer are exceedingly low. Also, this was her first mammogram raising the risk that the mammogram would result in a false positive. The reporting did not discuss these issues. This would have been a good opportunity to educate the public on this fact, particularly for women at age 40 who opt to have a mammogram which is only recommended by the US Preventive Services Task Force and the American Academy of Family Physicians in women 40-49 after careful risk assessment and shared decision making with the patient. Even the American Cancer Society doesn’t recommend routine mammograms until the age of 45. None of that appeared to happen here.
So this episode was the byproduct of an apparently unquestioning alliance between a marketing person and a local TV news celebrity.
More harm than good?
The most infuriating part of this whole story is that it probably sent a number of women in for earlier than needed mammograms and then generated fear, anxiety, and potentially needless additional interventions for numerous women.
Stories like the Washington Post’s amplified the misinformation with lines like this:
And she’s done what she set out to do: communicate that even women far younger than the typical breast cancer victim should get regular mammograms.
One who was far younger when she was diagnosed is Mandy Stahre, an editorial contributor to HealthNewsReview.org for years who learned she had breast cancer at age 31. Stahre earned her MPH and PhD in epidemiology. She wrote to me that awareness campaigns are starting to do more harm than good:
The video clip did more fear-mongering than fact-giving. No, not all women should be getting mammograms. Having mammograms does not lower a person’s risk of getting cancer. They are not a way of getting ‘control’ over cancer.
We’ve been down this road many times with TV celebrities telling their “my life was saved by screening” stories.
Medical writer/editor Gayle Sulik, PhD, who wrote the book Pink Ribbon Blues: How Breast Cancer Culture Undermines Women’s Health said this story echoes that of Good Morning America correspondent Amy Robach, who received an unspecified breast cancer diagnosis after an on-air mammogram in 2013. Like Robach’s story six years ago, Sulik said the recent story misses:
- details on the actual biology, staging, and likelihood of recurrence of the diagnosis. Without this context, readers are let with the misleading idea that all breast cancers are the same.
- the meaning of “no evidence of disease.” The absence of such evidence now does not mean a person’s life is saved.
- information about harms, risks, and potential, though limited, benefits of screening. Instead, the message is that mammograms are all good.