New treatments or technologies are often presented in the media as “breakthroughs” that promise unqualified advances.5 Even though breakthrough technologies are rare and unpredictable, media reports encourage the hope that such a technology for breast cancer detection is lurking in the shadows. In fact, virtually all medical technology development has its roots in basic research, and the world of research is so well-lit by the pressure to publish that there are few, if any, dark corners in which important technology advances lie hidden. Moreover, the technical backgrounds of members of the committee responsible for this report including surgery, radiology, molecular biology, imaging, physics, information technology, and epidemiology should ensure sufficient access to events in the research and development community to assure readers that the committee is not overlooking truly promising new developments.
Research indicates that women tend to overestimate their lifetime risk of developing and dying from breast cancer, and particularly the likelihood of that happening before age 50 (reviewed by Burke and colleagues).1,4,6,7,13,15,19 Many women mistakenly believe that their short-term risk of breast cancer diminishes with age.8,10,20 Investigating the media as a possible source of such misperceptions, Burke and his colleagues examined 172 vignettes illustrating women’s experiences with breast cancer that appeared in a broad sample of popular U.S. magazines over a four-year period.7 The age distribution of women in the vignettes was almost the reverse of the actual age distribution of breast cancer (Figure 1-1). Nearly half of the vignettes featured women diagnosed with breast cancer before age 40; such women account for only about 5 percent of breast cancer cases. Yet, the vignettes rarely referred to women age 60 or above with breast cancer, which is when the majority of cases occur.4,10
Gripping stories that generate fear of breast cancer in young women may also increase demand for tests and treatments perceived to improve the chances of surviving this disease. Hundreds of articles and television stories in the early 1990s portrayed high-dose chemotherapy (which included bone marrow transplantation) as the only hope for patients with advanced breast cancer, despite a lack of evidence that this risky and expensive procedure actually extended survival.5 In the mid-1980s, about 100 women per year received high-dose chemotherapy; in 1994, more than 4,000 of these procedures were performed. Similarly, deceptive marketing of MRI for breast cancer screening played on women’s desire for an “accurate” test (Box 1-3).