The Susan G. Komen Foundation "oversells" mammograms by using misleading statistics in ads, according to an Aug. 2 article in the medical journal BMJ by Geisel School of Medicine professors Lisa Schwartz Med'96 and Steven Woloshin Med'96. The article, which has received widespread media attention, is the second in a series of articles in the BMJ that highlight distortions of health information in the media, according to Schwartz.
Woloshin and Schwartz are director and co-director of the Center for Medicine and Media at The Dartmouth Institute for Health Policy and Clinical Practice. The center focuses on developing "healthy skepticism" in the general public and a more balanced understanding of medical care, according to the center's website.
The two doctors took issue with what they interpreted to be the message of the ad "If you don't get screened, then you're responsible," Woloshin said. In an interview with The Dartmouth, Schwartz and Woloshin emphasized the importance of showing both sides of screening, which includes potential harm as well as benefits.
"We can give people the choice," Schwartz said, adding that the Komen Foundation ads do not present screening as a choice.
The article highlighted ways that one prominent Breast Cancer Awareness Month ad misled readers with statistics.
According to the ad, the five-year breast cancer survival rate for those who detect the cancer early is 98 percent, while that of those who do not is 23 percent. Schwartz and Woloshin point out, however, that early detection by definition increases the amount of time between when patients discover they have breast cancer and when they die, but does not necessarily increase their total lifespan.
"Survival statistics tell you nothing about how effective the screening is," Woloshin said.
Woloshin likened early detection to a recurring scene in "The Rocky and Bullwinkle Show" in which a character ties a woman to railroad tracks in front of an oncoming train. Early detection, Woloshin said, is like giving women with tumors binoculars to see the oncoming train. Although the binoculars do not change the timing of the woman's death if the tumor is left untreated, she is aware of its imminent arrival earlier.
Regular screening can also raise the risk of overdiagnosis and false alarms, according to Woloshin.
Some cancers picked up by the screenings are too slow-growing to actually cause harm to patients, he said. Removing these tumors, as well as subjecting patients to radiation and chemotherapy, can only be harmful. For every one woman whose life is saved by early detection, two to 10 women are overdiagnosed, according to the BMJ article.
Response to the article has been generally supportive, Schwartz said. Various writers for women's magazines have already contacted her for advice on how to report breast cancer statistics with more accuracy, she said.
In a statement issued by the Komen Foundation, Chandini Portteus, vice president of research, evaluation and scientific programs, said, "The numbers are not in question. Early detection allows for early treatment, which gives women the best chance of surviving breast cancer."
The Komen Foundation declined interview requests by The Dartmouth and has not contacted Schwartz or Woloshin. This article is the second public blow to the foundation this year, following a national controversy in which the foundation announced plans to remove its funding for Planned Parenthood, though that policy was reversed in response to public outcry.
Schwartz emphasized her desire to change ad campaigns so that they no longer use fear as a tactic to encourage screening. Messages to the public about screening should be "less simplistic" and more honest, she said.
"The idea is telling different stories," she said, adding that often the only story the public hears is that of the woman whose life is saved by early detection. "There are many more sides to this."
This article is not the first written by Schwartz and Woloshin to call attention to "informed screening," Schwartz said, though this is their first to target the Komen Foundation.
"The biggest theme of our work is to improve communication of what medicine can and can't do," Schwartz said.
