Breast cancer awareness programs across the country are now having to reshuffle their media plans to educate millions of American women confused about whether mammograms will help save their lives.
Several weeks ago, National Institutes of Health (NIH) in Bethesda, Md., convened a panel concluding there was not enough evidence to support routine mammograms for women in their 40s. Essentially, the panel said the decision is ultimately up to the women themselves and their doctors.
The findings created a field day among many in the media who have taken the study to mean that mammograms are unnecessary for those women. For example, the Boston Globe ran a front-page headline the day after the panel findings, touting "Panel won't recommend mammograms for women in 40s" and Newsday ran an article with the headline, "NIH Adds Uncertainty to the Mammogram Debate."
While the issue can be boiled down to a gray area of 10 years --according to the American Cancer Society, of the 184,300 American women diagnosed with breast cancer last year, 33,400 were in their 40s. Breast cancer is the leading cause of cancer death for women in that age group.
However, the American Cancer Society, the American College of Obstetricians and Gynecologists and the American College of Radiology recommend that all women receive screening mammograms every one to two years beginning at age 40.
The decision put major health organizations at odds with one another. For example, the ACS recently issued a scathing press release in response to the panel recommendations.
"We find it especially troubling that the panel would issue a pessimistic statement, and conclude once again that the burden of decision for a women in her 40s is hers alone," said the American Cancer Society statement.
The Atlanta-based ACS also has alerted all of its member offices of its stance that women over 40 should have a yearly mammogram and is planning an educational campaign aimed at women in their 40s.
While a budget has not been set for the campaign, PR director Lisa Glasier said the awareness program will include television, radio and magazine advertisements about the importance of self-evaluations and talking with their doctors about when mammograms are right forthem.
However, Glasier said the new message will be less pointed than other classic campaigns such as the Great American Smokeout or Don't Be A Dragon Lady.
"It's hard to educate people about such decisions in our sound bite world," said Glasier. "With `Just say No' and `Just Do it' --`discuss mammograms with your doctor' is not as effective."
Breast cancer awareness advocates are worried that the new recommendations will not help women prevent cancer.
"Every year the experts seem to change their attitude on this - depending on who is doing the study," said Harriet Legum, a breast cancer activist. "It gets me so angry because we are sending out mixed messages."
Legum, a breast cancer survivor, has raised money for breast cancer research and public education programs for Johns Hopkins Medical Center in Baltimore, Md., about the importance of early cancer detection with the help of mammography.
Legum said the articles in the media may encourage women to skip breast examinations.
"No one wants to think that they're going to get breast cancer," she said. "If you're in your 40s, a natural instinct after hearing this latest news may be to say, `Whew, aren't I lucky! I don't have to go until I'm 50!' And the reality is if someone with cancer is seen at an early stage, their chance of survival is much greater."
While the ACS clearly disagrees with the recommendations, the New York-based Women's National Health Network and the Center for Medical Consumers in Atlanta approved of the panel's conclusion because it emphasized what they consider to be the shortcomings of mammograms: The tests can lead to further costly and stressful tests that may prove negative and they can also give women a false sense of reassurance.
Tracey Read-Will of the Mayo Clinic in Rochester, Minn., said the recommendations echo the messages the hospital has been telling its patients all along. "We won't change any of our communications plans because we have always encouraged women to talk to their doctors and make a personal choice," she said.
Indirect PR --Using Doctors To Communicate To Women
"The recommendations make it clear that the decision is one each woman, regardless of age, should make individually. Doctors will be in charge of the communication, he or she can explain the pros and cons of having a mammogram and clarify the limits of the test," said Dr. Nagi Khouri, medical director of Johns Hopkins Imaging in Baltimore, Md.
Khouri is involved in a federally-funded program aimed at teaching gynecologists and primary care physicians nationwide how to examine their patients' breasts.
Khouri and his associates have met with about 100 doctors across the country lecturing them about the correct procedures. He said that breast cancer awareness programs should try to educate physicians in addition to the general public because the NCI's recommendations on mammograms make the decision very personal.
"The highest percentage of lumps are detected by women themselves," said Khouri. "Doctors will be key in educating their patients about this."
(ACS, 404/320-3333, Johns Hopkins Breast Center, 410-955-4851, Johns Hopkins Imaging, 410-583-2700, Mayo Clinic )