This weekend over 1,600 surgeons will be in Las Vegas for the 18th Annual Meeting of the American Society of Breast Surgeons.
Media coverage of this conference is usually substantial for several reasons; not the least of which is that breast cancer is second only to skin cancer as the most commonly diagnosed cancer in American women.
Roughly 1 in 3 of newly diagnosed cancers in women will be breast cancers. Although the incidence of breast cancer has been dropping for nearly two decades, this year alone it is expected that over 250,000 women will be diagnosed with invasive breast cancer.
Another reason for the attention may be that breast cancer — not unlike prostate cancer in men — generates a fair amount of controversy when it comes to screening and treatment choices.
Finally, as with most cancers, the emotional toll of breast cancer is considerable and adds gravitas to both the statistics and controversy.
Given this I’m curious to see how the breast surgery conference will be covered by reporters. I’m also interested in what a veteran surgeon thinks should be covered.
So we’ll do this in two parts:
- Part one (pre-conference): What are the hot topics? How have they traditionally been covered? Or, what hasn’t been covered enough?
- Part two (post-conference): What sort of coverage actually came out of the conference? What can be learned from it?
“Can you give me 3 quotes or 3 sound bites?”
“The hot topics at the conference will be the genetics of breast cancer, DCIS (ductal carcinoma in situ), and screening mammography,” says Dr. Deanna Attai, a UCLA breast surgeon and immediate past president of the American Society of Breast Surgeons. (Dr. Attai is also a much valued member of our editorial team.)
“These topics are controversial and complicated so it takes time to understand the background and nuance. The last few interviews I’ve done I’ve been impressed with the level of questioning by reporters. But I still get those who say: ‘can you give me 3 quotes or 3 sound bites?’ It’s just not that simple. Too many news stories don’t have the word count needed to capture the complexity and nuance.”
Nowhere is this more apparent than with ductal carcinoma in situ, or DCIS: the presence of abnormal cells inside a milk duct of the breast (in situ means “in its original place”). Sometime these cells spread outside the duct to become invasive cancer. That’s why some people label DCIS a “cancer.” But DCIS can also stay in the duct, never spread, and that’s why you’ll hear others argue it should not be labeled “cancer” at all.
Doctors can’t predict which type a woman has so the question of whether to simply do surgery and err on the safe side is an ongoing debate. And because DCIS is predominantly diagnosed by mammogram (characterized by clusters of white calcium specks), and mammography is becoming increasingly sophisticated, more DCIS is being diagnosed. This leaves doctors, patients — and journalists — hungry for the latest information on what can mammography, genetics or other cellular characteristics tell us about who will develop invasive cancer and who won’t.
A bias in coverage?
Because conferences like this weekend’s in Las Vegas are a major pipeline of such new information, the quality of the reporting on the conference can indirectly impact the quality of breast cancer treatment. How? The treatment of both DCIS and invasive breast cancer rely heavily upon shared decision-making between women and their physicians. Well-informed patients are better equipped to make informed decisions along with their doctor.
“There is still a large camp that thinks DCIS is ‘cancer’ and needs to be treated as such,” says Attai. “And for certain cases that is certainly a ‘yes.’ But for a growing number of cases we’ve probably been overdiagnosing and overtreating.”
How big a problem is overdiagnosis? A Danish study published last month in the Annals of Internal Medicine found the following:
- If you don’t include DCIS cases in the tallies, anywhere from 14.7% to 38.6% of breast cancers found via screening represent overdiagnosis
- If you do include DCIS cases in the tallies, anywhere from 24.4% to as high as 48.3% of breast cancers found via screening represent overdiagnosis
Those are big numbers. But they don’t get big coverage. Instead, Dr. Attai has noticed a tendency of reporters to preferentially focus on early detection and cure.
“We have to get away from the messaging that ‘early detection leads to cure.’ Because while that may be true in some cases and, while ‘cure’ may not be the only endpoint, certainly early detection may also lead to less aggressive and less invasive treatment. And I think that is a very valid endpoint as well.”
You don’t have to dig far to find reporting which promotes early detection equals cure; often without much context. Last year, just a week after the American Society of Breast Surgeons held their annual conference in Texas, Fox News in Milwaukee ran a story entitled, Regardless of whether there’s a family history of breast cancer, early detection saves lives . The story featured a woman named “Beth” who received a diagnosis of breast cancer of unknown type after a routine mammogram. Contrary to the title of the video, it’s mentioned her sister and mother had breast cancer, and concludes with the patient advising “start (screening) as early as you can and just go.” The video is devoid of important context.
This weekend’s conference will also address the topic of “survivorship”; that is, what are the challenges women face after being treated. Attai says it’s something that matters the most to her patients but “doesn’t get much media attention.” It features prominently in the conference and it will be interesting to see if, and how, it is covered.
“As a breast surgeon I follow my patients long term and see the damage that treatment does to patients, ” says Attai. “With our modern treatment we can cure more people but that comes at a price … it’s what Dr. Susan Love calls the ‘collateral damage’ of cancer treatment. I need to do better with this. We all need to do better. It’s no longer enough to say we cured your cancer.”
And for health care journalists it’s no longer enough to cover medical conferences like this one and and simply parrot results. I ask Attai what advice she would have for reporters covering this weekend’s conference:
“There needs to an understanding that ‘one size fits all’ is not appropriate. Not all DCIS and invasive cancer are the same. I know it takes time but I hope journalists will take the time and do the research needed to understand the complexities and nuances. It’s getting there, many are doing a great job, but more needs to happen.”
The 18th Annual Meeting of the American Society of Breast Surgeons runs through this Sunday, April 30th.
Next week, in Part Two of this series, we’ll take a look at some of the news coverage from the conference and see how it measures up to Dr. Attai’s view of what she thought worthy of coverage, and was the coverage itself worthy.
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