Websites overemphasize benefits of cancer screening, study shows
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Public-facing websites of cancer screening programs in the United States often fail to present balanced information about the possible benefits and harms of screening, according to an analysis published in the Annals of Internal Medicine.
“The U.S. Preventive Services Task Force recommends that individuals at high risk for lung cancer consider benefits and harms before pursuing lung cancer screening,” Stephen D. Clark, MD, an instructor in the division of general medicine and clinical epidemiology in the department of medicine at the University of North Carolina School of Medicine, and colleagues wrote. “Medical centers develop websites for their lung cancer screening programs, but to date little is known about the websites’ portrayal of benefits and harms or what next steps they recommend for individuals considering screening.”
Researchers conducted a cross-sectional content analysis of the lung cancer screening program websites of 81 academic medical centers and 81 state-matched community medical centers. The locations were randomly selected from a list of American College of Radiology lung cancer screening-designated centers that were not oncology centers or radiology-specific imaging centers.
Clark and colleagues found that overall, the lung cancer screening program websites described the potential benefits more often than they described any potential harms (98% vs. 48%; P < .01). False-positive findings were the most frequently reported potential harm of screening (44%). Community centers were less likely than academic centers to report any potential harm (40% vs. 57%; P = .03), potential harm from radiation (25% vs. 43%; P = .01) and overdiagnosis (0% vs. 14%; P < .01).
Further, 119 websites (73%) did not specifically recommend that individuals personally consider the potential benefits and harms of screening; community centers were less likely than academic centers to give this recommendation (19% vs. 35%; P = .02). While 97% of the institutions listed follow-up steps for screening, few (22%) recommended that individuals discuss benefits and harms of screening with a health care a professional.
The researchers noted that the imbalance of information on the websites is “consistent with historical approaches to cancer screening advertising, which ignore or minimize potential harms and costs.”
In a related editorial, Steven Woloshin, MD, professor of medicine at The Dartmouth Institute, and colleagues wrote that the balance between the benefits and harms of screening is “often a close call” — underscoring the importance of shared decision-making between patients and physicians. However, “shared decision-making can only be as good as the quality of the information being conveyed,” they warned.
They further suggested that screening centers post the National Cancer Institute’s Patient and Physician Guide alongside their ads — a single-page document Woloshin and colleagues helped to create in 2012 that distills the findings from a large trial that examined the mortality benefit from screening. – by Janel Miller
Disclosures: Clark reports no relevant financial disclosures. Woloshin reports being a founding member of the board for the Scientific Committee of the Preventing Overdiagnosis conference and a member of the science committee and therefore, received travel subsidy but no other compensation. Please see the study and editorial for all other authors’ relevant financial disclosures.
Perspective
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Martin J. Edelman, MD
Lung cancer screening has now been validated in several large trials that have demonstrated that low-dose CT scans can reduce the risk for death from lung cancer. However, as with all medical procedures, there are risks. While the risks are clearly outweighed by the benefits when CT screening in properly implemented, they are still present, and it is essential that they be understood by the individual to be screened.
The paper by Clark and colleagues from the University of North Carolina analyzes the presentation of risk and benefit by hospital websites. They found that many of these websites overemphasize benefits compared with risks. Further, those programs that fail to adequately present risk are disproportionately nonacademic centers. This is not surprising given the rise of the business approach to all aspects of medicine and the use of screening as a “loss leader” to bring patients into the system where more expensive procedures and tests can be performed. While academic centers are certainly not innocent of this approach, they are frequently restrained by the necessity of maintaining their reputations in the medical community and perhaps greater influence by medical as opposed to business professionals in formulating the presentation of services.
It is important to recognize that the paper only discusses the website aspects of the programs and provides no information regarding what is actually discussed with the patient prior to actual screening. Therefore, the picture is incomplete.
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