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March is colorectal cancer awareness month. Screening saves lives. The question is: when to start? Our newly-published analysis of media coverage of this question, led by Dr. Anna Krigel of @nyphospital @ColumbiaMed in collaboration with @VPrasadMDMPH: https://mayocl.in/2VCdqH3
In 2018, when the American Cancer Society announced that screening average-risk individuals begin at age 45 (instead of 50) this garnered a great deal of attention.
Much focus was on the events that prompted the change from age 50 to 45, i.e. a rise (small in absolute magnitude but large in relative terms) in CRC rates in people younger than 50.
Anecdotally, we observed that certain aspects of this new recommendation were being under-emphasized: 1) that it was a “qualified” (i.e. weak) recommendation; and 2) that it was based on modeling studies, not on clinical studies showing that screening this age group saved lives.
So we set out to formally study how these guidelines were disseminated by the media. We identified 45 unique articles from 190 news outlets during the 30 days subsequent to the publication of the new guidelines.
Of the 45 articles, only 15 (33.3%) mentioned the “qualified” nature of the recommendation and only 17 (37.8%) mentioned that it was based on modeling data.
Half of the patients featured in news stories about these guidelines were younger than age 45 at the time of their CRC diagnosis, i.e. would not have benefited from this change.
Why are these details omitted? And why feature patients who don't fit the guidelines? Perhaps in some cases there was misunderstanding/error, but I suspect that these journalists knew but decided that telling a compelling story is more important, even if details muddy the waters.
Good health journalism is key to informing the public and advancing public health. Raising awareness of young-onset CRC can encourage more testing among people with symptoms.
But among average-risk individuals who feel fine, presenting these guidelines in this way could theoretically result in net harm. How?
Increasing screening rates among healthy 45-49 year-olds free of symptoms may impact our capacity to screen the ~30% of Americans >50 who have not yet been screened for one reason or another.
This latter population may be harder to reach, given that they have not been screened despite recommendations being on the books for ~20 years. These populations may be in underserved communities.
Opening our screening rolls to everyone at age 45-49 may paradoxically result in decreasing screening rates in these underserved populations. There are no data to support that this will happen, but this strikes me as a sound theoretical concern.
This should be the story, one of concern about unintended consequences and about expanding screening efforts to populations who have benefited less to date. Health journalists should not be afraid to handle the gray areas and controversy when the next set of guidelines arrive.
