As a healthcare leader responsible for diagnostic imaging services, I would like to share an example of health misinformation that was utilized to create guidance policies related to breast cancer screening. Wilner and Holton (202) define misinformation as false or inaccurate information regardless of intentional authorship (Wilner & Holton, 2020). The Ontario Breast Screening Program (OBSP), a program run by Cancer Care Ontario, outlines who is eligible for self-referred bi-annual screening mammograms (CCO, n.d.). Since it’s inception, the OBSP (n.d.) has recommended that most eligible women, Two-spirit, trans and nonbinary people ages 50 to 74 are eligible to get screened with mammography every 2 years (CCO, n.d.). This age range of 50 to74 has also been implemented in screening programs across Canada and the United States (Kopans, 2022; Yong-Hing et al., 2023; Wilner & Holton, 2020). I would assume that this guidance was based upon peer-reviewed studies on the efficacy of screening mammography to detect cancer early, resulting in decreased mortality due to this illness. I was surprised to learn that this may not be the case. Is it possible that that programs run by our regulatory bodies could be based on false or inaccurate information?
Does the scientific literature support an age range of 50 to 74 for breast screening?
I was surprised to learn that the scientific literature does not support a starting age of 50 for mammography screening. Kopans (2022) has summarized that randomized controlled trials of mammography screening has proven that the optimal age range to save lives is 40 to 74 (Kopans, 2022). Moreover, Yong-Hing et al (2023) has identified that current guidelines relied on research conducted in the 1960s to the 1980s, including one study which has now been discredited (Yong-Hing et al, 2023).
What are the potential public health implications?
There are many potential public health implications related to the use of an incorrect age range for screening mammography. Firstly, this misinformation about breast screening and the guidelines, as Yong-Hing et al have suggested, can decrease confidence in screening mammography and can lead to suboptimal recommendations Yong-Hing et al (2023). To receive funding for screening mammography, diagnostic services must follow the OBSP guidelines. Now that I am aware that theses recommendations did not accurately reflect the optimal age range that was scientifically proven, my confidence in our regulatory body has been weakened. Secondly, there are many health benefits that can be achieved through the early detection of breast cancer. As summarized by Yong-Hing et al (2023), screening mammography has been shown to reduce the rate of advanced stage breast cancers by 25% and reduce breast cancer mortality by 41% in screened women starting at the age of 40 (Yong-Hing et al, 2023).Moreover, Kopans (2022) has identified a reduced need for mastectomies, less need for surgical interventions such as axillary dissections, less need for toxic systemic therapy such as radiation and chemotherapy and ultimately saved lives through decreased mortality rates (Kopans, 2022). These treatment regimes could be avoided for those patients who have breast cancer identified through routine screen at the age of 50, if they were eligible earlier. To support their patients, health practitioners, as identified by Wilner and Holton (2020) must be aware of the myths circulating about breast cancer prevention and treatment and be prepared to both dismantle misinformation and to stress reliable health guidance (Wilner & Holton, 2020).
Conclusion
I agree with Kopans (2022) who stated that the promulgation of misinformation needs to stop and all women and their physicians need to be provided with scientifically valid information to make informed decisions (Kopans, 2022). There is a glimmer of hope that our trust in the healthcare system can be strengthened again. In Ontario, in the Fall of 2024, patients will be able to self-refer for a screening mammogram beginning at the age of 40 (Government of Ontario, 2023). A small step forward after years of inaction on the utilization of misinformed screening ages based on inaccurate information.
References
Cancer Care Ontario. (n.d.). Ontario breast screening program (OBSP). Screening Programs. https://www.cancercareontario.ca/en/cancer-care-ontario/programs/screening-programs/ontario-breast-obsp
Government of Ontario. (2023, December, 20). Breast cancer testing and prevention. Health and Wellness. https://www.ontario.ca/page/breast-cancer-testing-and-prevention
Kopans, D. B. (2022). Misinformation and Facts about Breast Cancer Screening. Current Oncology, 29(8), 5644–5654. https://doi.org/10.3390/curroncol29080445
Wilner, T., & Holton, A. (2020). Breast cancer prevention and treatment: Misinformation on pinterest, 2018. American Journal of Public Health, 110, S300–S304. https://doi.org/10.2105/AJPH.2020.305812
Yong-Hing, C. J., Gordon, P. B., Appavoo, S., Fitzgerald, S. R., & Seely, J. M. (2023). Addressing Misinformation About the Canadian Breast Screening Guidelines. Canadian Association of Radiologists Journal, 74(2), 388–397. https://doi.org/10.1177/08465371221120798
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