Dartmouth researchers attack Komen ad, saying it preys on women’s fears

By Deborah Kotz, Globe Staff

Susan G Komen for the Cure ad that ran last October

After writing recently about the benefits and drawbacks of PSA screening for prostate cancer, I received several e-mails from male readers wondering why I wasn’t being as skeptical about breast cancer screening. One reader wrote that his guess was “if this article was about mammograms and gynecological testing it would have never seen the light of day.”

I responded to these readers that some public health experts have raised concerns about women being oversold on the life-saving benefits of mammography -- which are actually quite small -- without being fully informed about the risks of screening. These include unnecessary biopsies for X-ray findings that turn out to be benign, and overtreatment for early breast cancers that might have never become life-threatening.

In fact, two physicians from the Dartmouth Institute for Health Policy and Clinical Practice wrote a scathing column in the British Medical Journal last week criticizing Susan G. Komen for the Cure for an ad campaign the nonprofit patient advocacy organization ran last October during Breast Cancer Awareness Month. The ad, pictured above with the researchers’ commentary, advocated for mammography screening by telling women that they were “key” to surviving breast cancer.

“It’s a misleading message implying that women only get bad breast cancers if they don’t have a mammogram,” said Dr. Lisa Schwartz, an associate professor of medicine at the institute who co-authored the column. “That’s not really true since the worst cancers can appear between mammograms.”

Women are also made to feel guilty if they’re diagnosed with an aggressive breast cancer, as if it’s somehow their fault because they didn’t do everything they could to catch the cancer early.

While it’s true that early detection of breast cancer does save some women’s lives, Schwartz pointed out that the Komen ad dramatically overstated the benefits of screening by stating that the five-year survival rate for breast cancer when caught early is 98 percent, and when caught late, it’s 23 percent.

The ad should have used other statistics -- the risk of dying of breast cancer -- to more accurately reflect the benefits of mammograms, she said. Earlier detection, by definition, lengthens survival rates -- the time a patient lives after diagnosis -- but it doesn’t necessarily mean the patient will live longer than they would have if the cancer was found later.

Komen vice president Chandini Portteus responded in a statement that “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.”

The Komen website, unlike the above ad, delves into the nuances of mammography, pointing out that the X-ray may miss up to 30 percent of breast cancers and often lead to followup tests for false-postive findings.

Komen isn’t alone in running ads that prey on our fears. Many medical organizations take this tack, which not only raises our anxiety levels, said Schwartz, but also lulls us into a false sense of security -- as if all we need to do is get a screening test or dab on some sunscreen and we’ve shielded ourselves against the deadly effects of cancer.

“The evidence that sunscreen reduces melanoma deaths is pretty much nonexistent,” said Schwartz. That didn’t stop the American Cancer Society from running an ad a few years ago featuring a young woman holding a photo of her dead sister with the caption “my sister accidentally killed herself; she died of skin cancer,” to advocate for sunscreen use.

Another ad campaign from a patient advocacy group trying to raise awareness about thyroid cancer recently featured a 14-year-old girl with the words “check your neck; confidence kills,” implying that children should be worried enough about the cancer -- which is rare in young people -- to regularly run their hands over their neck looking for a tumor.

There’s a fine line between ads that make us aware of certain diseases and their symptoms in order to get properly diagnosed and treated and those that leave us feeling doomed to a life of illness. “Can we feel healthy when we’re reminded that we’re sick all the time?” asked Schwartz. “These groups need to find ways to educate without using fear as part of their tactic.”

The trouble is, fear grabs our attention, which makes those scary ads effective -- getting us to worry and take action -- even if we aren’t made aware of the negative consequences that some actions can have.