Distorting the diagnosis

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The Article

The big story for women last month was the apparent “about face” on the value of breast self-exams (BSE). After years of impressing on women the absolute necessity of this practice, the Canadian Cancer Society announced that monthly BSEs were no longer a recommended practice.

Since it was Breast Cancer Awareness Month, the shocking announcement was quickly parlayed into headlines emphasizing the abrupt reversal. E.g., “Don’t bother with breast self-exams” (Globe and Mail); and “Self exams on breasts dismissed” (National Post). Consequently, many women were led to believe that BSEs were, for lack of a better word, a bust.

But that was the wrong message. As with most medical stories, the truth is in the details, not the headlines. In this case, the missing detail was the Canadian Cancer Society’s all-important caveat, “It is still important for women to look at and feel their breasts to detect any changes in them. The new message is that they don’t need a specific technique or schedule to do so.”

Since looking at and feeling breasts to detect changes is essentially a BSE, the Cancer Society’s actual message was for women to perform BSEs more often (not just once a month), and to do so as part of a broader health regime that includes regular mammograms and clinical exams.

This was not communicated in the headlines. It emerged only in the follow-up stories that appeared days later: “Still a case for checking your breasts” (Globe and Mail), “Early detection is still crucial for treating breast cancer” (Vancouver Sun). The overall message was never properly clarified, and many women remain confused or misguided as a result.

Ubiquitous pink-ribbon campaigns and massive media coverage have succeeded in generating awareness about breast cancer, and encouraging women to take responsibility for their health. But in an age when medical discoveries come thick and fast, and the rules for preventing and treating breast cancer are constantly shifting, women also need accurate, up-to-date information. Unfortunately, as this episode shows, the media have failed women in that regard.

Consider another example. A 2001 Danish study determined mammograms were useless in preventing death by breast cancer. The results from this one study conflicted with years of evidence demonstrating otherwise. Yet the front-page headlines that appeared around the world gave readers the impression that the new findings were conclusive. As a result, droves of women opted out of screening programs. Within two years, the Danish study was debunked as deeply flawed.

The same pattern repeated in 2002, when a study supposedly reported that Hormone Replacement Therapy (HRT) increased the risk of heart disease and breast cancer. The media went into overdrive with its headlines (e.g., “The New Carcinogens,” Time), and many fearful women quit their HRT regimes.

Once again, the headlines were misleading. The study in question examined the issue of whether HRT could prevent heart disease in a group of older women (average age: 67) who already had signs of heart disease and hoped HRT would keep it at bay. It didn’t. But not preventing heart disease is very different than causing heart disease and breast cancer.

Publication in peer-reviewed journals is a months-long—sometimes years-long—process. And so media-savvy medical researchers have an incentive to employ the lay media to inform the public and help establish precedence for discoveries, generate public interest, and attract grants and investment.

This relatively new process could be significant in stimulating more timely public debate and policy changes about health-care. But such benefits depend entirely on how the media tell the story, and they are clearly limited when accuracy is sacrificed for sensational headlines..

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