Media coverage of screening guideline changes: A case study

By Judith Garber | March 9, 2020

In 2018, the American Cancer Society released a new guideline recommending that regular screening for colorectal cancer (CRC) start at 45 for patients with average risk, rather than the current recommended age of 50. The guideline update was based on studies from 2017 that found a rise in the incidence of CRC among people younger than 50.

As we noted on our blog, most of the media coverage of this change emphasized the benefits of screening, but few reports put these benefits in context or examined the potential harms.

For example, the 22% relative increase in CRC incidence and 13% increase in mortality among people under 50 was widely covered. However, most reports did not mention that the absolute rate of CRC incidence for young people only increased from 0.0059% to 0.0072%. Nor did they mention that the estimated benefits of screening younger people are lower than most people would expect.

Just in time for colorectal cancer awareness month, a study was published that digs deeper into the media coverage on this issue and validates our initial observations. In a recent analysis in the Mayo Clinic Proceedings, Dr. Anna Kriegel and Dr. Benjamin Lebwohl at Columbia University and Dr. Vinay Prasad at Oregon Health and Science University examined media coverage of the ACS colorectal cancer screening guideline change.

Here’s what they found:

Out of 45 different articles and press releases, just 15 (one third) mentioned that the ACS recommendation is considered a “qualified” recommendation as opposed to a strong recommendation.
Only 17 of the 45 pieces included that the ACS recommendation is based on modeling simulations, not a new clinical trial.
More than half of the articles (27/45) mentioned that other professional societies, such as the US Preventive Services Task Force and the US Multi-Society Task Force on Colorectal Cancer, do not recommend this change.
While most of the articles included a quote from a physician outside of the ACS committee, only 11 articles quoted physicians who “expressed reservations about the guideline update.”

We noted on our blog in 2018 that some doctors and patient advocates were using the guideline change as an opportunity to raise awareness about CRC in general. In articles covering the guideline change, several young survivors of colorectal cancer shared stories of how their doctors ignored their symptoms or how they didn’t recognize the signs of potential cancer.

Kriegel et al. saw a similar pattern in their media analysis. They found that half of the patients interviewed in articles about the CRC guideline change were diagnosed before age 45. These patients would not have benefitted from the revised recommendation, but they were in favor of raising awareness that CRC can happen to younger people.

Learning the symptoms of CRC and listening to patients is crucial for proper diagnosis of CRC. But is screening asymptomatic people at a younger age the best solution to this problem? Lowering the screening age is a blunt tool that will lead to thousands of people having unnecessary colonoscopies, along with potential complications and financial costs.

“Why feature patients who don’t fit the guidelines?” asked study author Lebwohl on Twitter. “I suspect that these journalists knew but decided that telling a compelling story is more important, even if details muddy the waters,” he wrote.

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