How a charity oversells mammography.

Like US Independence Day, Thanksgiving, and Christmas, disease awareness has made it into the US calendar. In 2012 we have 175 officially designated “national health observances,” including rabies day, sleep awareness week, endometriosis awareness month, and many observances for heart disease and a variety of cancers.None is more prominent than breast cancer awareness month, otherwise known as “October.” And no organisation has done more to promote this observance than Susan G Komen for the Cure, the world’s largest breast cancer charity and creator of the ubiquitous “pink ribbon,” which each year aims to “turn the country pink for national breast cancer awareness month.” 3 Komen’s portfolio of activities includes a variety of laudable efforts “to save lives, empower people, ensure quality care for all, and energize science to find the cures.” But the charity is best known for promoting mammography screening. Unfortunately, there is a big mismatch between the strength of evidence in support of screening and the strength of Komen’s advocacy for it. A growing and increasingly accepted body of evidence shows that although screening may reduce a woman’s chance of dying from breast cancer by a small amount, it also causes major harms. 6 In fact, the benefits and harms are so evenly balanced that the National Breast Cancer Coalition, a major US network of patient and professional organisations, “believes there is insufficient evidence to recommend for or against universal mammography in any age group of women.” Even the chief medical officer of the American Cancer Society, which has long promoted screening, calls for balanced information to ensure that women understand the benefits and harms of mammography. Recently in the United Kingdom an independent panel began reviewing the evidence for mammography to help the NHS decide whether the balance of benefits and harms justifies its national screening programme. In contrast, Komen’s public advertising campaign gives women no sense that screening is a close call. Instead it simply tells women to be screened, overstates the benefit of mammography, and ignores harms altogether. Consider the advertisement featured prominently in a national promotional blitz during the most recent breast cancer awareness month (figure).