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Washington Post media columnist Howard Kurtz strayed beyond media observations and injected his own comments about the US Preventive Services Task Force breast screening recommendations.

He calls the task force recommendation a "don't-worry-be-happy-till-you're-50 finding."

He defines "the essential problem with such studies" as "in the end it's a very personal decision."

Exactly. And that was the entire point of the USPSTF recommendation - that women need to weigh the harms and benefits in consultation with their doctors. But Kurtz must not have read that far.

And then he goes on to cite a list of journalists who wrote about their own personal opposition to the recommendations.

But he didn't quote even one person who wrote in a more balanced way about the evidence behind the recommendations. So, while his column was headlined, "A battle over breasts," he didn't present much about "the other side" in this battle.

Then again, Kurtz has exhibited an advocacy stance for the screen-screen-screen mentality in the past in his handling of a friend's promotion of prostate cancer screening.

My friend Robert Davis writes about five popular falsehoods he's seen this week in the "the widespread confusion, consternation, and even anger that the new (US Preventive Services Task Force mammography) guidelines have unleashed." His five:

1. This is all about saving money.

2. This is about rationing.

3. Early detection saves lives.

4. The fact that I or someone I know was saved by a mammogram proves that more testing is better.

5. The shifting recommendations prove that scientists are clueless.

Read his entire column. He's a smart guy and his summary is insightful.

I am a frequent critic of TV health news - and especially of much of this week's TV coverage of the US Preventive Services Task Force mammography recommendations. So I want to make special note this week of some of the fine work by Dr. Nancy Snyderman on this issue. I've seen several examples where she offered more explanation and context than her network TV competitors.

Case in point: this clip on yesterday's NBC Today Show.

In it, Snyderman said: "What we as a population were unwilling to accept - which has become very apparent in the last 48 hours - is that we didn't like the message." Yet she emphasized that the message was what the science shows.

She said HHS secretary Sebelius threw the task force under the bus and oversimplified the message by telling women "keep doing what you're doing."

She said "emotion, anecdote, lobbying, advocacy groups, doctors and patients" led to a political reversal.

She said "This is the role of scientists to take the emotion out of the science. That was their charge - look at the hard numbers and give recommendations back."

While she editorialized on Sebelius, her even-handed comments on the work of the task force stood in sharp contrast to some of what was broadcast on ABC, CBS, CNN and Fox.

More on the reactions to the US Preventive Services Task Force mammography recommendations. Susan Perry writes on MinnPost.com about:

"... the rampant, breathless fear-mongering rhetoric that has framed much of the media's response to the recommendations. ...

On ABC's daytime talk show "The View," co-host Elisabeth Hasselbeck made the stunning claim that the recommendations were "gender genocide."

I can't tell you how many times I've used that line in interviews recently.

So it was refreshing to see someone else - Steven Pearlstein - use it today in the Washington Post. (* Actually, either he or the copy desk butchered the quote, leaving out the "not." Surely they meant well, but the quote and the point makes no sense without it, and indeed, is NOT what the standard line is. I've added it in the following excerpt with a * and hope the Post corrects this soon.)

"I should acknowledge that I have no idea who should and should not get routine mammograms. But I know enough about statistics to say that the issue is not settled just because you know of someone in her 40s whose breast cancer was detected by a mammogram and cured. As economists and medical researchers are fond of saying, the plural of anecdote is *(not) data. ...

As is often the case in such matters, those raising the most fuss were those with greatest financial interest in mammography (the radiologists and the makers of mammography machines) and the disease groups (in this case, the American Cancer Society), which tend to resist recognizing limits on how much time, money and attention is devoted to their cause.

"How many mothers, sisters, aunts, grandmothers, daughters and friends are we willing to lose to breast cancer while the debate goes on about the limitations of mammography?" Otis Brawley, chief medical officer of the American Cancer Society, asked in an op-ed article in Thursday's Washington Post. Dr. Brawley cleverly didn't answer his own question, but the clear implication of his question was that the only acceptable number should be zero. And it is that very attitude, applied across the board to every patient and every disease, which goes a long way in explaining why ours is the most expensive, and one of the least effective, health-care systems in the industrialized world."

In the stories reported by major news organizations all across the US, there have been countless quotes that make wild, unsubstantiated charges about the motivation behind the US Preventive Services Task Force's breast screening recommendations.

A quote in a New York Times story yesterday:

"Why all of a sudden this change?" said Karen Sun, 41, who was loading her groceries into her car here in Los Angeles. "It feels out of nowhere."

As the Washington Post led with in their story, this has been a decades-long debate. What we have seen in the past 3 days is akin to what happened with the uproar 12 years ago after a NIH Consensus Conference on this issue made a concluding statement that many women - and their politicians - disagreed with.

In an ugly clash between science and politics, confusion reigned.

And now it's happening again.

From the LA Times:

Some Republicans jumped on the report as the kind of government intervention in medical decisions that Obama's healthcare plan would bring.

"This is really the first step toward that business of rationing care based on cost," said Rep. Phil Gingrey (R-Ga.), a physician.

Where is the evidence for that? That is fear-mongering rhetoric.

In the Washington Post:

"We can't allow the insurance industry to continue to drive health-care decisions," said Rep. Debbie Wasserman Schultz (D-Fla.), who said earlier this year that she had undergone treatment for breast cancer.

Wasserman-Schultz, whose legislation promoting breast cancer education in young women was widely criticized by evidence-based experts, should be forced to produce evidence for her claim as well.

And on ABC last night, a physician was allowed to say - unchallenged - that mammograms pick up early cancers when they need less treatment. If anecdotes are going to rule the day, then that physician should have to counter the anecdotes I've heard from women whose early DCIS or ductal carcinoma in situ - often called "pre-malignant" or "pre-cancerous" - was picked up by mammograms. And the range of treatment options then thrown at them - as aggressive as prophylatic bilateral mastectomy - left the DCIS-diagnosed to wish that they had actually received a diagnosis of invasive cancer because the choices were easier and more clear cut. These are real stories I heard from real women. The story - the discussion - isn't complete without taking into account the experiences of women like that.

I watched all three TV networks' lead stories from last night's newscasts - all three on the US Preventive Services Task Force's new breast cancer screening recommendations. Lots of talk about "anger, confusion, concern, fear, outright revolt, disturbing, shocking" reactions from women and doctors all across the country.

First, I'll note a reasonably well-balanced job by CBS' Dr. Jon LaPook and by NBC's Dr. Nancy Snyderman. LaPook included a woman who had experienced a false positive mammogram. Snyderman talked about data versus personal anecdotes.

But ABC's Dr. Timothy Johnson gave a personal recommendation - perhaps only because he was asked to by anchor Charles Gibson - and recommended "sticking with the current guidelines." He said he understood concerns about costs and quality. But that misses the underpinning of much of the USPSTF's recommendation and rationale. It implies that the USPSTF considered costs, which they have repeatedly reiterated they did not. He never addressed false positives and the harms thereof. So his summary was misleading and incomplete.

And CBS again allowed Dr. Jennifer Ashton to give her own personal medical opinion, saying "I am not telling (women) to deviate from their screening practices."

I have a lot of problems with the networks giving airtime to the opinions of their physician-correspondents. Do they ask political reporters about their voting habits? Do they ask economics reporters what their investments are? Do they ask the White House correspondent if they personally like the President or support his stances?

I don't personally care what Timothy Johnson or Jennifer Ashton recommend - and I don't think there's any reason for anyone in the viewing audience to care. In this venue, they are supposed to be journalists. Not recommenders. Not opinion-promoters.

Instead of promoting their celebrity docs, the networks should use that precious air time to educate people on the evidence behind the USPSTF recommendations.

All three networks - and many other news organizations - are treating this issue as if it's new. There never has been certainty about mammography recommendations for women in their 40s. And it was just 12 years ago that an NIH Consensus Conference on this issue resulted in a great uproar - what one editorialist described as "what took place seemed more akin to the Queen's order in Alice's Adventures in Wonderland: "Off with her head!" Thus began the latest round in the debate over recommendations for breast-cancer screening."

Journalism has to take responsibility for conveying far too much certainty about screening issues. And at times like this, when evidence-based bodies speak up, journalists - and the public they serve - act as if their worlds have been shaken. But, in fact, their world on this issue never was cast in concrete. Anyone who spends anytime following this issue would know that.

In the face of the confusion, journalists can fuel the flames by interviewing endless women about their personal anecdotes. Or they can explain, give context, history, guide readers and viewers through the confusion.

I've been asked by students in the past, "How much do we screen for prostate cancer in the US compared with other countries?" Now there are some new numbers to help answer that question.

An article in HealthAffairs (Cancer Screening And Age In The United States And Europe. Howard et al. Health Affairs.2009; 28: 1838-1847- subscription required for online access) compares screening rates in the US and in Europe on a number of different screening tests.

But the prostate screening results jumped out at me.

In 50-64 year old men, we screen more than any European country except Austria - and that's a close call. In men this age, we screen twice as much as Finland, Sweden and Spain - almost three times as much as the Netherlands, and almost four times as much as Great Britain and Greece. We screen a whopping 7.5 times more than Denmark in this age category.

In the 65-74 year old category we screen more than any European nation - by far.

And in men 75 and older, we screen more than any European country except - again, Austria.

Some, of course, will say this is a good thing.

I don't think we can know that unless we know the rate of truly informed decisions that led up to these screening tests.

And, as previously reported on this blog, a recent Archives of Internal Medicine study showed that the quality of discussions between US men and their doctors on prostate cancer is not optimal. The authors wrote:

The finding that 30.1% of subjects underwent PSA testing without first discussing screening... is a disconcerting finding. Only 20.6% of discussions presented both the pros and cons of screening and elicited the subject's preferences for testing.

And, as the HealthAffairs authors point out, we're paying for this: "The results point to an overlooked source of high U.S. per capita health spending: the U.S. health care system pursues a more aggressive approach to detecting and treating patients with subclinical disease."

Amidst the flood of stories that only reflect the benefits of cancer screening, here's a story from the UK - and the Sunday Times - that delivers the perspective of the harms of screening that we seldom hear. It begins:

Jane Flanders was not aware of the risks involved in being screened for breast cancer when she received her invitation from the National Health Service four years ago.

After being diagnosed with cancer and undergoing extensive surgery, the mother of two now wishes she had not attended. She believes she was the victim of over-diagnosis.

The 56-year-old maths teacher from Basingstoke, Hampshire, was diagnosed with ductal carcinoma in situ, a dormant cancer which was not spreading and may never have caused problems.

Doctors advised her to have radical treatment -- including a mastectomy -- in case it might spread.

"Screening has caused me considerable and lasting harm. It has certainly not saved or prolonged my life," she said.

"The reality of this diagnosis has been two wide excisions, one partial mutilation (sorry, mastectomy), one reconstruction, five weeks' radiotherapy, chronic infection, four bouts of cellulitis (a bacterial infection), several general anaesthetics and more than a year off work."

Flanders believes it is "outrageous" that the NHS has withheld information on the risks. The government has been forced to rewrite its advice to include warnings about potential harm caused by the screening process.

It's a TV sweeps ratings period, and it's also breast cancer awareness month, so any boob could see this coming.

The Washington Post makes a big deal of the fact that DC station WJLA is making an even bigger deal about:

"...breaking TV's unspoken taboo by showing two women fully exposed on its late-afternoon and evening newscasts."

...

WJLA acknowledges, however, that the timing of its stories may raise some eyebrows: The reports will air on the first two days of TV's traditional "sweeps" month, a period in which stations air their most eye-catching stories to boost ratings that are used to set advertising rates.

WJLA general manager Bill Lord said he had no qualms about the timing of the reports, or in promoting them beforehand. "People will say we're doing it just for ratings," he said. "But we're a commercial television station -- we're trying to get people to watch us. Yes, this is an attention-getting story, but it's also an important story."

Tell me that even this dramatic viewer warning about their online video isn't meant to titillate:

But the Post story buries the real story, only deep in the story getting to the question of how newsworthy this really is:

"The effectiveness of self-exams as an early cancer-detection method, however, has been questioned in recent years. The National Breast Cancer Coalition says medical studies suggest that the exams are not useful and can lead to "elevated anxiety, more frequent physician visits and unnecessary biopsies of benign lumps."

The American Cancer Society says self-exams play only "a small role" in finding breast cancer. On its Web site, the society says "it's okay not to do [a self examination] or not to do it on a fixed schedule."

At least the Post touched on these issues. The WJLA report never did.

But good luck telling that to a TV news director in the middle of a ratings period.

And good luck trying to talk about evidence (or lack thereof) when a naked breast can give you the bump in the ratings you need so badly.

Now, will they do the same thing for testicular cancer?

New media writer Jeff Jarvis, recently diagnosed and treated for prostate cancer, is writing about screening again:

"I say, thank god science for screening."

He's entitled to his opinion.

He is not entitled to his own personal version of the facts. He writes:

"There is a growing rumble about curtailing screening."

No. That is simply wrong. There is no move for "curtailing" screening. There are many, however, who are calling for better and more balanced presentation of the potential harms - not just the potential benefits - of such screening.

That is not curtailing. It is not rationing. Nothing would be taken away from anyone.

This kind of talk is classic fear-mongering. When Dr. Otis Brawley of the Cancer Society spoke up about the limitations of screening last week, I read where one pro-screening crusader commented that this is "another sign of Obama health care."

Wow. But I've often thought that the screening camps are as polarized as political camps. It's just that the screening camps tend to be these:

1. Those who think that EVERYONE should be screened.
2. Those who wouldn't promote screening nor deny it to anyone, but, rather, would better inform men.

Jarvis concludes his recent column:

"As a matter of statistics and odds, I know screening results in treatment that adds to costs. But it also saves lives - no matter whether we know precisely how many. I believe screening saved my life and I chose not to have been proven right by waiting.

So get your screenings, folks, get 'em while they last."

No one is taking anything away. It's not a matter of "get 'em while they last." That's absurd.

I'm pleased to see that my op-ed piece in the Buffalo News may, at least in some small way, have more people there and elsewhere talking about a more complete picture of the not-so-simple prostate cancer screening decision.

First, it led the Roswell Park cancer center to post an "important message" on its website. In it, Dr. James Mohler, chairman of urology at Roswell Park wrote,

Talking to one's doctor about screening is not the same as being treated, and we believe that Mr. Schwitzer muddies those issues. Is his takeaway message to men: Don't talk to your physician? Is it: What you know can hurt you?

I don't believe my message was muddled at all. And there was nothing in my message that even indirectly hinted at discouraging men from talking with their doctors. What I wrote about was the uneven, imbalanced, incomplete promotion of prostate cancer screening. Whether the information comes from a news story, an ad, from your doctor, or from a website promotion, it should be balanced and as complete as possible. There is no reason why the Roswell Park prostate club promotion had to be so simplistic and incomplete.

Finally, after the op-ed section of the Buffalo News published my editorial, the news department published a news story on the recent public screening discussions. In it, Roswell Park's Dr. Mohler was again quoted:

"What we're seeing is the unintelligent use of the PSA test. We need to be screening everyone at risk of death and not everyone," said Dr. Mohler.

"The PSA has overshot its goal," he said. "It often finds prostate cancer when it is so low-risk that it doesn't need to be treated," he said. "But you also can't deny that the death rate for prostate cancer has fallen 40 percent since the PSA."

Actually, anyone in epidemiology or biostatistics would remind you that one of the explanations for a falling death rate could be that the pool of prostate cancer has become so expanded after the introduction of the PSA blood test. So if you're finding many more abnormalities very early - what some would even call pseudo-cancers - but still calling them cancers - and saw no improvement in treatment, you could still see a dramatic fall in the death rate because the pool of "cancers" - the denominator - would be so much larger.

This, too, is part of the education of the American public that needs to take place.

Katie Hobson of USNWR:

"it's not hard to see why a diagnosis of DCIS is confusing and frustrating. On one hand, you're told not to worry; you do not have invasive cancer and most likely never will (the 10-year survival rate is almost 100 percent, with treatment). On the other, you're told you need to have the cells surgically removed and, in some cases, may need radiation. So really, it's not so far off from what you'd go through if you did have cancer. And even though DCIS is almost always treated, scientists agree that not all cases would ever have turned dangerous. How did we get into this situation? And how do we get out of it?"

A shortened version of what first appeared on this blog now appears on the op-ed page of the Buffalo News.