31 Days of “Little Known” FACTS — For Breast Cancer Awareness Month — Day 31 — Trick or Truth?

“Galileo’s head was on the block. His crime was looking up the truth.” – Indigo Girls

Did you know…

Clever TRICKS are used to manipulate the TRUTH about mammography screening.

The TRICKS are explained in a Time Magazine article, This One Graphic Will Change the Way You Look at Breast Cancer Screening written by Gerd Gigerenzer, Director of the Harding Center for Risk Literacy at the Max Planck Institute for Human Development in Berlin and author of Risk Savvy: How to Make Good Decisions.

Gigerenzer states: “Information about the actual benefits and harms of screening has been held back for years. Pink ribbons and teddy bears, rather than hard facts, dominate the discourse.

Why is that? It’s not because the information is hazy. No other cancer screening has been studied so extensively. The fact box below outlines benefits and harms. It is based on half a million women in North America and Europe who participated in randomized clinical trials, half of whom attended screening and half of whom did not. The fact box shows what happened to them 10 years later:

Trick #1: State that screening reduces breast cancer mortality by 20% or more, because it sounds more impressive than explaining that the absolute risk reduction is 1 in 1,000.

This trick has been used for years in pamphlets. You might think, well, it’s not much, but at least one life is saved. But even that is not true. The number of deaths from all cancers, breast cancer included, is the same in both groups, as seen in line two of the fact box. And that leads us to trick #2:

Trick #2: Don’t mention that mammography screening doesn’t reduce the chance of dying from cancer. Talk only about the reduction in dying from breast cancer.

Often, and particularly if a person had multiple cancers, the exact cause of death is unclear. For this reason, total cancer mortality is the more reliable information when you look at it in terms of the larger goal: saving lives. In plain words, there is no evidence to date that routine mammography screening saves lives.

Now let’s look at the harms.

Trick #3: Don’t tell women about unnecessary surgery, biopsies and other harms from overtreatment. If you are asked, play these down.

The first way a mammogram can harm women is if it comes back with a false positive, leading to invasive and unnecessary biopsies. This isn’t the rare fluke most people seem to think it is. This happens to about a hundred out of every thousand women who participated in screening. Legions of women have suffered from this procedure and the related anxieties. After false alarms, many worried for months, developing sleeping problems and affecting relationships with family and friends.

Second, not all breast cancers are life-threatening. Women who have a nonprogressive or slowly growing form that they would never have noticed during their lifetime often undergo lumpectomy, mastectomy, toxic chemotherapy or other interventions that have no benefit for them and that are often accompanied with damaging side-effects. This happened to about five women out of a thousand who participated in screening.

There’s one final trick I would like to share with you.

Trick #4: Tell women about increased survival. For instance, “If you participate in screening and breast cancer is detected, your survival rate is 98%.” Don’t mention mortality.

Susan G. Komen uses this trick, as do many health brochures. How can 1 in 1,000 be the same as 98%? Good question. Five-year survival rates are measured from the time that cancer is diagnosed. What this means is that early diagnoses only seem to increase the rate of survival; it doesn’t mean that 98% were cured, or even lived longer than they would have without an early diagnosis from a mammogram. What’s more, screening also detects nonprogressive cancers, which further inflate short-term survival rates without having any effect on longevity. For those reasons, survival rates are often criticized as misleading when it comes to the benefits of screening. What you really need to know is the mortality rate. Again, look at the fact box, which uses neither 5-year-survival rates nor other misleading statistics such as relative risk reductions.

Thanks to these tricks, quite a few doctors (perhaps yours?) are inadequately informed as well. But again, why is the misinformation so widely spread? Like those who refused to peer through Galileo’s telescope for fear of what they would see, many who have financial or personal stakes in screening and cancer treatment—from medical businesses to patient advocacy groups sponsored by the industry—close their eyes to the scientific evidence and cling to a one-sided view.

Mass screening is not the key to saving lives from cancer; the effective means are better therapy and healthier lifestyles. About half of all cancers in the U.S. are due to behavior: 20-30% to smoking; 10-20% to obesity and its causes, such as lack of exercise; and about 10% and 3% to alcohol in men and women, respectively. With respect to breast cancer, less alcohol and a less sedentary lifestyle with more physical activity, such as 30 minutes of walking a day, can help.

Until five years ago, cancer screening brochures from organizations in Germany (where I live) used all four of the above tricks to advocate screening. That is no longer so. All misleading statistics have been axed, and for the first time harms are explained, including how often they occur. However, none of the organizations have yet dared to publish a fact box, which would make the evidence crystal clear to everyone. Then, every woman could finally make an informed decision on her own.”

Thank you Gerd Gigerenzer for explaining all the TRICKS –and shining a light on the TRUTH.

Learn more @ #Be W I S E

#BeW I S E is a woman’s health initiative with an urgent public health mission — to ensure all women are properly informed about serious potential harms of breast cancer screening.

About Donna Pinto

I am originally from New Jersey and moved to Los Angeles with my family at age 12. After graduating from San Diego State University with a BA in Journalism, I had a short-stint in magazine advertising sales before landing my "dream job" with Club Med. For two years I worked at resorts in Mexico, The Bahamas, The Dominican Republic and Colorado. My husband Glenn & I met in Ixtapa, Mexico and we embarked on a two year honeymoon around the world. This was also a research project for a book we wrote called "When The Travel Bug Bites: Creative Ways to Earn, Save and Stay Abroad." I am also the author of a quote book for new graduates -- "Cheatnotes on Life: Lessons From The Classroom of Life." In 1997, we settled in San Diego and I was blessed to work part-time from home for non-profit organizations while raising our two boys. In 2010, a DCIS diagnosis changed my life. DCIS 411 is the culmination of my on-going journey and discoveries.
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6 Responses to 31 Days of “Little Known” FACTS — For Breast Cancer Awareness Month — Day 31 — Trick or Truth?

  1. Janet says:

    Thank you Donna for these very informative posts I have read each one for the past 30 days. This has been more helpful than any of the same litany we get every year from the Pink Campaign and all the others. I wish I had never had a mammogram and went through all the over treatment I did starting in 1999 with my first diagnosis of DCIS and my second diagnosis in 2012. I no longer subject myself to mammograms since I’m determined to save my right breast. Unfortunately I had mastectomy and reconstruction on my left side because I had radiation with the first round of DCIS in 1999. I can’t change my past decisions however I’m glad I never took tamoxifen and didn’t have a double mastectomy, I especially liked the statistics on how few lives are saved from screening versus all the harms. I continue to heal and find peace and remain healthy. I look forward to more interesting news and appreciate all you do to keep us informed. Best Regards, Janet

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  2. ann galluzzo says:

    Hi Donna I loved your thirty one day posts I wish you could do that often they were very helpful I hated to see them end I looked forward to them every day Thank You Ann

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  3. Sandra says:

    Thanks for all your efforts to help educate people about the harms of over-diagnosis and over-treatment of breast cancer. Since finding out the truth about mammograms and DCIS, it’s very hard for me to trust the medical profession. I wish they realized the harm they are doing with their scare tactics and misleading statistics. Why can’t they state the simple truth and trust women to make their own decisions? Some women would choose aggressive treatment of possibly indolent cancer cells, and other women would choose not to. Each person should be fully informed and allowed to decide for herself, based on her own assessment of the risk and her own willingness to undergo treatment.

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