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A Project of The Annenberg Public Policy Center

Breast Cancer Ballyhoo

This ad from Americans for Prosperity caught our eye because of the sheer number of falsehoods it hits on, both new ones and old faithfuls. The group, whose president helped organize the Tea Party protests, is spending $750,000 to run this very misleading ad in nine states.

In the ad, breast cancer survivor Tracy Walsh denounces new government guidelines on mammograms, which she says “[save] money, but could cost your life.” She claims the “guidelines” say that “women shouldn’t receive mammograms until age 50.” According to Walsh’s script, the guidelines were devised by a “government panel that didn’t include cancer experts,” and if health care legislation is passed, such guidelines “could become the law for all kinds of diseases.”

For starters, while the media tended to call the U.S. Preventive Services Task Force’s updated recommendations for cancer screening “guidelines,” the word implies a degree of prescriptiveness that’s not really accurate. The task force issued recommendations, not rules, and they have been plenty controversial. In 2002, the group recommended mammograms every one to two years for women between ages 40 and 70. Last year, the panel said mammograms for women under age 50 should be an individual choice, and it recommended mammograms every two years for women over age 50.

The National Cancer Institute has announced intentions to evaluate the recommendations and possibly incorporate them into its own suggestions for cancer prevention, but the American Cancer Society has rejected the recommendations and so has the Susan G. Komen Foundation. Even the government, in the person of Health and Human Services Secretary Kathleen Sebelius, distanced itself from the recommendations and advised women to stay the course.

Sebelius: The [USPSTF] is an outside independent panel of doctors and scientists who make recommendations. They do not set federal policy and they don’t determine what services are covered by the federal government. … Mammograms have always been an important life-saving tool in the fight against breast cancer and they still are today.

Whether the task force is a “government panel” that does not include “cancer experts” is something of a matter of definition. It’s true that USPSTF is sponsored by the Agency for Healthcare Research and Quality, part of the Department of Health and Human Services, but its members are doctors and professors from the private sector. And it’s true that the panel is largely made up of primary care physicians, some of whom have a particular focus in preventive medicine, rather than oncologists. All members have either M.D.s or Ph.D.s in medicine; one has both. There’s one public health expert and two epidemiologists (doctors who study the spread of disease, including cancer). And the previous recommendations came from the same “government panel that didn’t include cancer experts.”

The ad makes the new suggestions sound like a dramatic shift in direction, from recommending yearly mammograms to demanding no mammograms at all. That’s not the case. Even in its 2002 recommendations, USPSTF said that “the balance of benefits and potential harms of mammography improves with increasing age for women between the ages of 40 and 70,” that “available trials also have not reported a clear advantage of annual mammography over biennial mammography” for women between ages 40 and 50, and that for women over 50 there’s still “little evidence” that it’s better to get a mammogram every year than every two years. A family history or other risk factors, the panel said, should strengthen the recommendation of routine mammography.

The 2009 recommendations, based on a review of existing cancer research, state that “[t]he decision to start regular, biennial screening mammography before the age of 50 years should be an individual one and take patient context into account, including the patient’s values regarding specific benefits and harms.” That’s a C recommendation, meaning that “there is at least moderate certainty that the net benefit is small” and that the USPSTF suggests offering the service only if other factors support it. And it’s a far cry from saying that “women shouldn’t receive mammograms until age 50,” as the ad claims.

Walsh says that “if I had followed the new government guidelines on mammograms, my cancer would have spread undetected.” That’s not only misleading (the USPSTF recommendations aren’t “new government guidelines”), it’s flat-out false. As Walsh says in the ad, her mother died of breast cancer. In her case, even a doctor who was stringently following the USPSTF recommendations would have suggested mammograms at an earlier age. Walsh goes on to continue to imply that if the government had its way, women wouldn’t get treatment for breast cancer. That’s absurd. “If you find a lump, you could wait months for treatment and life-saving drugs can be restricted,” she says. Nowhere did the task force guidelines say that women who find lumps should be denied access to mammograms – on the contrary, it said that the decision to get mammography “should be an individual one and take patient context into account.”

As for breast cancer survival rates, early screening certainly improves those. What’s less clear is whether screening actually improves survival, versus improving the statistics we use to measure it. We’ve written about this a few times before — including in our analysis of a previous misleading ad featuring Walsh.

Walsh’s claim that survival rates for breast cancer are notably higher in the U.S. than in the E.U. is backed up by a study published in the medical journal Lancet, which showed five-year relative survival rates of 83.9 percent in the U.S. and 73.1 percent for the European average. Five-year relative survival rates show the number of cancer patients who are still alive five years after diagnosis, compared with how many people would be expected to be alive in a healthy population. That means that early detection will always improve the five-year relative survival rate — more patients will be alive five years after diagnosis if their cancer is caught early in its course, regardless of whether they ultimately die from the disease. Breast cancer mortality rates — the number of people who died from breast cancer within a given period — are remarkably similar in the U.S. and the U.K., which recommends mammograms every three years starting at age 50.

We talked to a number of experts for our previous article who said that mortality rates were a more accurate statistic for comparing disease outcomes of different countries. The USPSTF’s conclusion is that the improvement in breast cancer outcomes from yearly mammograms starting at age 40 doesn’t outweigh the potential harm associated with the test, mostly harm from potential false positives. Mortality rate comparisons back up that assessment, and survival rate comparisons don’t necessarily challenge it.

At any rate, the comparison with European health care is beside the point. Congress is not considering “government-run health care” or passing a bill in which “the government takes over your health care,” as the ad puts it. As we’ve noted so many times recently, the legislation pending in Congress builds on our current system of private insurance. Most people would continue to get insurance through their employers, the way they do now, and others who buy individual private coverage would be able to do so through a new system that is likely to offer them more choices than they currently have.

— Jess Henig