Cancer screening stories need to report on the uncertainties

A Miami Herald story, heralds “Prostate cancer hits younger men.”  You know right away how this one is going to play out.

The story begins by profiling a 48-year old man with prostate cancer.  It says his “doctor ordered the test as a routine practice for his male patients.”  There isn’t any discussion about how such ordering as a routine practice doesn’t demonstrate the kind of shared decision-making model that the American Cancer Society and other organizations recommend before screening occurs. It says that urologists strongly oppose the US Preventive Services Task Force’s recently revised recommendations on prostate cancer screening, but no one from the USPSTF is heard from in the story.

The story says that the American Cancer Society recommends:  “Starting at age 50, men should talk with their doctor about the benefits and limitations of prostate screening.” I don’t think it’s splitting hairs to point out what the ACS actually says on its website:

The American Cancer Society recommends that men make an informed decision with their doctor about whether to be tested for prostate cancer. Research has not yet proven that the potential benefits of testing outweigh the harms of testing and treatment. The American Cancer Society believes that men should not be tested without learning about what we know and don’t know about the risks and possible benefits of testing and treatment.

Starting at age 50, talk to your doctor about the pros and cons of testing so you can decide if testing is the right choice for you.

As already noted, there’s a shared decision-making emphasis there that doesn’t appear in the story.  The story mentions “benefits and limitations.”  In order to make that discussion symmetrical, the common parlance is “benefits and harms” – or as ACS states, “pros and cons.”  “Benefits and limitations” may convey that there are only benefits, however limited.  The fact that true “harm” can occur from screening is an important part of public education.

The story also discusses treatment options.

  • It quotes a urologist saying, “With the emergence of robotic and minimally invasive surgery, it’s a cleaner, nicer procedure.” And a patient saying, “It’s less invasive, you recover faster.’’ But it didn’t reflect on the recent Journal of Clinical Oncology paper whose authors wrote that the reasons for the rapid spread of robotic prostatectomy are unclear, given the lack of randomized trials and few comparative studies, given that it’s more expensive and appears to have a long learning curve to achieve optimal outcomes.
  • It also discusses Cyberknife, but doesn’t mention perspectives like those in a recent Radiology Today story, wherein a scientist said the clinical evidence on the use of the CyberKnife for prostate cancer is “a little early … and a little weak. It’s still developing and cannot stand on its feet.”

We offer these comments as constructive criticism to help journalists realize how imbalanced their stories may be depending on whom they choose to interview and how limited is their research on the topic.

Here’s a better example: the San Francisco Chronicle published, “Debate grows over colorectal cancer screenings,” a story that reflects a much better grasp of the complexity of another screening issue.  And the end result is a story that helps readers understand the healthy debate that exists on screening issues.

The story begins by noting that most health professionals agree that colonoscopy “is the best, one-shot way to screen” for colon cancer.  “But,” the story’s nut graf explains,  “an increasing number of experts are beginning to voice support for alternative methods, which they say could be used more widely to prevent colorectal cancer, which occurs in the colon or rectum.” More:

“some professionals argue colonoscopy has been promoted as the “gold standard” to the point that other less invasive, lower cost options such as stool-sample screenings are routinely overlooked.

“I am not against colonoscopy. I’m against it being called the best test,” said Dr. James Allison, professor emeritus of medicine at UCSF and an adjunct investigator at the Kaiser Division of Research. He argued the New England Journal report showing that the colonoscopy is better than other available and recommended screening tests was not a randomized, controlled study. …

“What I argue with is recommending everybody have a colonoscopy,” Allison said, adding that the procedure comes with a small chance of complications, such as bleeding or bowel perforation, and that less than 5 percent of polyps have the potential to turn into cancer.

“We can’t do it, the country can’t afford it, and we don’t even know if it’s the right thing to do,” he said.

This latter story is an example of journalism that informs, digs a bit deeper, doesn’t advocate for simple answers that may be incomplete, and helps readers develop critical thinking skills about health care issues.

Debate is healthy.  Journalism should report on the uncertainties so as not to convey false certainty where it doesn’t exist.

Gary Schwitzer has specialized in health care journalism in his more than 30-year career in radio, television, interactive multimedia and the Internet.  He is publisher of HealthNewsReview.org.

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