Susan G Komen for the Cure is perhaps the world’s largest charitable organization dedicated to the cause of eradicating breast cancer. According to their website, they’re “the world’s largest grassroots network of breast cancer survivors and activists, we’re working together to save lives, empower people, ensure quality care for all and energize science to find the cures.” It appears however, that some researchers have taken issue with Komen’s 2011 ad campaign and have published a harsh rebuke in a recent article in the British Medical Journal (BMJ).
The controversy is focused particularly on Komen’s aggressive push for women to get screened based on what the authors say are “deceptive” ads. Pictured above, you can see an example of one of the questionable ads. Steven Woloshin, MD, and Lisa M. Schwartz, MD, of the VA Outcomes Group, Department of Veterans Affairs Medical Center, White River Junction, Vermont, and the Center for Medicine and the Media, The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire, begin their criticism by stating, “Unfortunately, there is a big mismatch between the strength of evidence in support of screening and the strength of Komen’s advocacy for it.” If you look at the picture above, you’ll see the claim that “early detection saves lives”. The ad also goes on to reflect statistics about the 5 year survival rate that the BMJ authors say are false. The article says that Komen’s ads give women the impression that they are crazy not to get screened however, according to the BMJ authors, “it’s the advertisement that is crazy”. They go on in their criticism by saying, “If there were an Oscar for misleading statistics, using survival statistics to judge the benefit of screening would win a lifetime achievement award hands down.”
So if you’re like me, you’re probably sitting their saying, ‘Whats the big deal?” In a nutshell, the authors are saying that quoting survival statistics is biased. When a tumor is not caught through screening, it isn’t detected until a lump is felt. Screening may catch that same tumor 5 years earlier. Their beef seems to be that the 5 year survival statistic begins at the time of diagnosis. “ Because screening finds cancers earlier, comparing survival between screened and unscreened women is hopelessly biased.” There also seems to be some disagreement among those in the medical community as to the necessity of these screenings. Woloshin and Schwartz also believe that Komen isn’t accurately representing the harm that can be done with early screening, such as over-diagnosis.
I contacted Komen’s media department for a statement and received this response from Chandini Portteus, Vice President of Research, Evaluation and Scientific Programs:
“Everyone agrees that mammography isn’t perfect, but it’s the best widely available detection tool that we have today. We’ve said for years that science has to do better, which is why Komen is putting millions of dollars into research to detect breast cancer before symptoms start, through biomarkers, for example.
“Komen also is funding research to help accurately predict which tumors will spread and which won’t. While we invest in getting those answers, we think it’s simply irresponsible to effectively discourage women from taking steps to know what’s going on with their health.
“We have long advocated for women to be informed about the benefits and risks of early detection and treatment. We encourage women to work with their healthcare providers to find out what’s right for them.
“At the same time, Komen is funding millions of dollars in community health programs that educate, screen and provide financial and social support for low-income and uninsured women through treatment.”
“The numbers are not in question. Early detection allows for early treatment, which gives women the best chance of surviving breast cancer.”
I also contacted Lisa Schwartz and asked her whether they made any attempt to contact Komen before they wrote this article. She responded:
“We did not speak to them – although we know that the NY Times did speak to them for the pinking of america article when they were using the same statistics to promote screening at a dallas cowboys game. The citation for the NY Times is in our paper.”
Here is the link to the NY Times article that Schwartz is referring to.
I have to say that I have mixed feelings about this article. While I do believe that it is important to keep women informed of all the pros and cons surrounding breast cancer screening, I can’t help but feel the punishment didn’t fit the crime in this instance. The fact that the study authors went so far as to call the ads ‘crazy” and accuse them of being worthy of a “lifetime achievement award” for misleading statistics without making the effort to contact Komen sends up red flags for me. There are also some murmurings that this is an attempt to save money. One of Charles Bankhead’s, staff writer for MedPage Today, articles, BMJ OpEd Says Komen Ads False has an interesting comment by a someone labeled as TTF:
“The article states: “For every life saved by mammography, the imaging leads to overdiagnosis of two to 10 women, many of whom receive unnecessary interventions and treatment, they added.” Komen is advertising about health benefits. The above quote is talking about a healthcare system cost-benefit ratio. For the patient, a false alarm is, to put it bluntly, still preferable to unnecessary death from a treatable cancer.”
I believe this person makes a relevant point. Hopefully, the medical community and Susan G Komen for the Cure can learn to communicate these concerns more directly. In the end, I believe it benefits the most important aspect of this story, the patient.