Fall is the season of change and it appears the American Cancer Society (ACS) is embracing it. During this month’s Breast Cancer Awareness Month, when you would typically hear “mammograms, mammograms, mammograms” as much as you hear “sunscreen, sunscreen, sunscreen” during the summer, the ACS released new guidelines recommending less and later screening, sparking uproar from practically every audience.
- Women with an average risk of breast cancer (no family history of breast cancer, no known inherited gene mutation and no personal history of breast cancer) should begin annual screening with mammograms at age 45, instead of age 40, as outlined in the previous guidelines. The ACS notes that women ages 40-44 can choose to begin getting mammograms, if they want to.
- Women should transition to screening every two years starting at age 55, but can also choose to continue screening annually.
- The ACS is no longer recommending a clinical breast exam (manual breast exam performed by a doctor). Breast self-exam is also no longer recommended as a screening method for women of any age.
Breast cancer remains the second leading cause of cancer death among women in the United States. A large number of women diagnosed with breast cancer have no history of breast cancer in their family. Why would the ACS recommend less screening?
The ACS’s new guidelines are based on an evidence-based review conducted by an outside group, the Duke University Evidence Synthesis Group, and assessed by a “voluntary panel of generalist clinicians, biostatisticians, epidemiologists, economists and patient representatives.” The ACS notes that there were no representatives from the health insurance industry on the panel and that all participants were required to disclose potential conflicts of interest.
The evidence showed that there is significantly less risk of cancer for women ages 40-44 and there is higher risk for harm from screenings, including biopsies for false-positive findings and overdiagnosis.
Clinical breast exams and self breast exams are no longer recommended, because there is very little evidence that they contribute to early breast cancer detection.
This is consistent with what many doctors have been emphasizing like broken records over the last several years – we now do more tests than ever with fewer benefits and more harm, which is driving up health care costs for everyone. Despite these facts, after nonstop messages about cancer prevention and early detection, the public has come to expect and rely on more screenings earlier.
Breaking the news – almost literally
The public reaction to these new guidelines was immediate and ferocious with the majority of people expressing disappointment, disgust and anger over the new guidelines.
- Local and national news media shared the new guidelines widely with coverage in every major news outlet from the Wall Street Journal and TIME to CNN and the HuffingtonPost. It was practically endless.
- Some newspaper Editorial Boards, including USA Today, even published opinion pieces voicing their opposition to the new guidelines.
- Health professionals in related fields, such as radiologists, submitted op-eds to national outlets emphasizing the continued importance of mammograms and their disappointment in the new recommendations.
- Susan G. Komen’s response was one of the most neutral on the day of the announcement, but they used the opportunity to emphasize their own priorities – the need for women to have accurate information, increased access to screening and more accurate, cost-effective screening.
- The loudest and most powerful voices were those of breast cancer survivors. April Sloan, who spoke with WSPA-TV in South Carolina, expressed a common theme among survivors:
I never imagined that I would be standing here today in 2015, breastless and speaking as a breast cancer survivor and advocate at the age of 39 years old…I’m angry about the new recommendations, because I was diagnosed at 36.
The ACS’s Strategy
It’s clear that the ACS expected the news to make waves. At the time of the announcement, they communicated widely and consistently and utilized the credibility of others to boost the credibility of the new guidelines. On day 1, the ACS:
- Launched a full landing page with information about the new guidelines, including a simple infographic, FAQ, news release, information specifically for professionals and more.
- Directed people to JAMA, a well-respected, peer-reviewed journal, for the full medical review, the resulting new guidelines and a review of the benefits and harms of breast cancer screening.
- Published a blog post with a full explanation of the new guidelines by Dr. J. Leonard Lichtenfeld, deputy chief medical officer for the national office of the ACS.
- Announced the new guidelines on Twitter, Facebook and YouTube.
Over the last week, the ACS has used social media to respond to comments and clarify the guidelines, and they have posted a second YouTube video with further explanation. They are sticking to their consistent messages. Public reaction has simmered slightly (as indicated by the change in tone in comments on the ACS’s Facebook posts over the last few days), though there is still a lot of anger.
What do you think of the ACS’s new guidelines? Do you think the ACS announced them well? What would you have done differently, if you had to announce something this controversial and personal to so many people?