In promotional material for the 2011 Breast Cancer Awareness Month, Susan G. Komen for the Cure suggested large differences in breast cancer survival among women who undergo screening mammography and those who do not. Specifically, the advertisement stated a 5-year survival of 98% when breast cancer is caught early and 23% when it is not.
In doing so, the organization ignored “a growing and increasingly accepted body of evidence [showing] that although screening may reduce a woman’s chance of dying from breast cancer by a small amount, it also causes major harms.”
“This benefit of mammography looks so big that it is hard to imagine why any one would forgo screening. She’d have to be crazy,” Steven Woloshin, MD, and Lisa M. Schwartz, MD, of the Department of Veterans Affairs Medical Center in White River Junction, Vt. and the Dartmouth Institute for Health Policy and Clinical Practice in Lebanon, N.H., wrote in an article published online in BMJ.
“But it’s the advertisement that is crazy,” they added.
In response to the BMJ article, Susan G. Komen for the Cure issued a statement from Chandini Portteus, vice president of research, evaluation, and scientific programs.
“Everyone agrees that mammography isn’t perfect, but it’s the best widely available detection tool that we have today,” said Portteus. “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.”
But Woloshin and Schwartz argued that the timing of breast cancer diagnosis has minimal impact on long-term survival, citing evidence that mammography reduces a 50-year-old woman’s 10-year risk of dying of breast cancer from 0.53% to 0.46%.
“Five-year survival is all about what happens from the time of diagnosis,” Woloshin and Schwartz wrote. “It is the proportion of women who are alive 5 years after diagnosis. Because screening finds cancers earlier, comparing survival between screened and unscreened women is hopelessly biased.”
The authors also faulted Komen’s deception for emphasizing the benefits of mammography but making no mention of the possible risks. Woloshin and Schwartz cited evidence indicating that 20% to 50% of women screened annually for a decade will have at least one “false alarm” that leads to a biopsy.
For every life saved by mammography, the imaging leads to overdiagnosis of two to 10 women, many of whom receive unnecessary interventions and treatment, they added.
With regard to the need for balanced information about mammography, Komen’s Portteus said, “We have long advocated for women to be informed about the benefits and risks of early detection and treatment. We encourage women to work with their healthcare providers to find out what’s right for them.
“At the same time, Komen is funding millions of dollars in community health programs that educate, screen, and provide financial and social support for low-income and uninsured women through treatment,” she added.
“Women need much more than marketing slogans about screening,” Woloshin and Schwartz concluded. “They need — and deserve — the facts. 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.”
Charles Bankhead is a staff writer at MedPage Today, where this article was originally published.