REVIEW

Breast cancer in the media – friend or enemy?

Mary Rice

Blueprint Partners, Brussels, Belgium

Keywords: Breast cancer; Media; Journalists; Reporting; Communication

I imagine that most of you sigh heavily each time youread a headline such as ‘New cancer treatments offerhope of longer life’. Quite probably you do not bother toread on, thinking that this is another example ofjournalists raising false hopes. If you do read more, itmay only be so that you know how to let your patientdown gently when she asks for the new treatment.But those of you who read this story, published last

Sunday in The Observer, a British newspaper, will knowthat it concerns the promise of the use of micro-arraysand the possibility that treatments that are tailor-madefor an individual will be widely available by the end ofthe next decade. It is in fact an accurate report of whatwas said by a number of eminent oncologists at abiotechnology conference in Scotland held in thepreceding week. This is a far-from-rare example of ajournalist getting it right, and giving sound informationas well as justified hope to the public.Why would you have been suspicious of this headline?

Why do science and the media make such uneasybedfellows? It is not difficult to understand. Science is aslow and methodical process, and scientists expect thattheir findings will be reported in detail, and that theinevitable conclusion ‘further research is needed’, will beproperly represented in news stories. Many doctors andscientists dislike the media because they think that ittrivialises their work – and they often feel that the mediagets it completely wrong, with all the worrying implica-tions for patients and the public that involves. Butmedia representatives often consider doctors and

scientists to be obsessed with irrelevant detail and tobe hopeless at communicating what they are doing – ifthey choose to communicate it at all.There are indeed examples of the media getting things

wrong, but they are fewer in number than most of youwould believe. A commonly held belief among scientistsis that tabloid papers are more likely to make mistakesthan broadsheets, whereas in fact the reverse is true. Ithink this may have something to do with the fact thatmedical researchers are less likely to read tabloids andare relying for their knowledge on the odd headline readover someone’s shoulder on public transport.What has all this got to do with breast cancer?

Well, all of us, scientists or not, get the majority ofour information about things that affect our daily livesfrom the media. And far more people get thatinformation from the popular press, magazines, radioand television than from the ‘serious’ newspapers. In thecase of breast cancer, which attracts more column inchesthan any other disease affecting women and is fre-quently written about in popular magazines, this isparticularly true. It is therefore in scientists’ interests totry to understand how the media works, and to use itto their advantage. It is also incumbent on the mediato report new studies responsibly, and not to raise falsehopes.It is very difficult to get this balance – between making

the story interesting and involving, and raising unjustifi-able hopes that cures and treatments are just round thecorner – right. Journalists are looking for a ‘news item’and are therefore interested in applications and implica-tions. Scientists are used to spending years on research,and then months on writing up the results.It is hard for them to understand either the journal-

ist’s timescale – the deadline is always hours away and

ARTICLE IN PRESS

The Breast (2003) 12, 417–419

0960-9776/$ - see front matter r 2003 Elsevier Ltd. All rights reserved.

doi:10.1016/S0960-9776(03)00146-2

Address correspondence to: Dr Mary Rice, Blueprint Partners sprl,

Rue du Luxembourg 19-21, B-1000 Brussels, Belgium.

Tel.: +32 22890937; Fax: +32 25130577;

E-mail: mary.rice@blueprintpartners.be

417

sometimes only minutes – or their interest in the humanangle. Putting together someone whose interest is how itis done and someone who only wants to know what itwill do can be a recipe for disaster.So why bother? I think there are a number of reasons

why medical researchers should keep trying. Above all,there is enormous public interest in medical science. In1988, at a time when the whole ‘public understanding ofscience’ movement was in its infancy, 2000 British adultswere shown this list of newspaper headlines and askedwhich one they would read (for those of you who areunfamiliar with British TV soap operas, Eastenders ispossibly the most popular programme ever on the BBC):

Heathrow robbery and drugs dealEastenders star in baby shockNew clue in hunt for AIDS cureRobots for housework soonFA Cup winners surpriseCan pesticides in rivers be controlled?Government backs massive investment in scienceUN calls for British action against South AfricaAstronomers discover new galaxy60’s pop idol in comeback‘Was Darwin right?’ say scientistsHeart disease own fault, expert claimsNew government cuts announced.

The vast majority said that they would first read thestory about heart disease. This was followed bygovernment cuts and the work on AIDS. Pesticideswere slightly more popular than astronomers – theycame fifth and sixth, respectively – and investment inscience came eighth. Clearly, people are aware thatmedical science is important and relevant to their lives.You can pick up any daily paper any day and you canbet that there will be at least one medical story in it. Itmay be on the problem page, on the sports page, or inthe women’s section, but it will be there, and it willusually be informative.So doctors and scientists who do not communicate

with the media are missing a golden opportunity toinform and educate the public, and hence to make theirlives a little simpler.But people with cancer – which many patients still

consider to be a death sentence – or those who are closeto them are desperate for help and often ignore anycaveats or qualifiers included in a story about apotentially promising treatment, however carefullythat story is written. Yet such patients and their families,far more than the general public, have a real needfor honest information, presented in an understandablemanner.

But when such straightforward matters as preventionstrategies, for example, are reported in very differentways, can anyone rely on the media to come up withreliable information?A study carried out in the US by Lisa Schwarz and

Steve Woloshin,1 which was published in JAMA lastyear, compared the approach of the news media toscreening mammography for women in their forties andtamoxifen for primary prevention of breast cancer. Theylooked at how US newspapers and television coveredthese two stories and found major differences.In January 1997, an NIH consensus panel said that

evidence did not support screening for women in theirforties. In March of the same year, under politicalpressure, the NCI changed its mind – and recommendedscreening. All the coverage portrayed mammography asthe right thing to do. ‘The harm of over-diagnosis wasn’tstressed’ said Schwarz.The tamixofen story dates from 1998, when the NIH

stopped a randomised trial of tamoxifen vs placebo inhigh-risk women, concluding that tamoxifen signifi-cantly reduced the incidence of breast cancer. Tamox-ifen stories mentioned the risk of uterine cancer, andsaid that women should weigh risks and benefits.Women were advised to rely on expert opinion abouthaving a mammogram but to decide for themselvesabout whether or not to take tamoxifen. Although thepotential harms of each preventive strategy werementioned, the negative effect of taking tamoxifenreceived greater emphasis. Although all the stories wereaccurate, the interpretations were very different.So why bother with the media? Like it or not, many

patients still do not trust their doctor to tell them thewhole truth. There is also plenty of evidence to showthat people with cancer are often so surprised andfrightened by their diagnosis that they remember verylittle else of the consultation. The media can play auseful role here, by helping to support opinion receivedfrom a medical professional both with further informa-tion and with a recital of facts already presented, butperhaps not entirely taken in or fully understood. I donot intend to talk at any length about the internet, whichwill be covered in a later presentation, but the lack ofquality control on many so-called medical websites andthe problems of discriminating between what is evi-dence-based knowledge and what is simply quackery,make the media’s role even more essential. There is,after all, some form of quality control in all the media. Ifa journalist gets things wrong too frequently andattracts lots of complaints from the public, he or shewill be fired.At the end of the day, though, is the media a friend or

enemy of people with breast cancer and those who treat

ARTICLE IN PRESS

418 The Breast

them? Maybe this too, is a decision for the individual.But the influence of newspapers, magazines, radio andtelevision on patients and their families makes it tooimportant to be overlooked or ignored. If the media is toact as a watchdog over major social institutions, if it isto mediate between medical science and the public andfacilitate public discourse about issues of health policy –for example, access to new drugs and treatments andavailability of specialist hospital facilities – then bothscientists and journalists need to accept and come toterms with an uneasy and sometimes adversarialrelationship.This is difficult for both sides, but there are signs that

things are improving. Almost all universities andacademic hospitals now have press offices, which canhelp facilitate the interaction between doctors andjournalists. A press release is often the most effectiveway both of communicating and of controlling amessage.

There is also an increasing tendency to include notjust patient communication training but also presenta-tion and media skills into degree courses, and this canonly be for the good as far as patients and their familiesare concerned.The biologist Jakob Bronowski summed it up neatly

when he talked about the need for a ‘democracy of theintellect’. He wrote: ‘We must not perish by the distancebetween the people and power that destroyed Nineveh,and Alexandria, and Romeyy. The distance can beclosed only if knowledge sits in the homes and heads ofthe people and not up in the isolated seats of power’.I think that says it all.

References

1. Schwartz L M, Woloshin S. News media coverage of screeningmammography for women in their 40s and tamoxifen for primaryprevention of breast cancer. JAMA 2002; 287(23): 3136–3142.

ARTICLE IN PRESS

Breast cancer and the media 419