Trust the evidence, not Kochie and Sam

WHEN television presenters decide to mount a health campaign, it’s not hard for things to go wrong.

The team at Channel 7’s morning program, Sunrise, probably thought they were doing their good deed for the year when they encouraged viewers to undergo a range of cancer screening tests.

Morning television is all about entertainment: the audience didn’t just receive advice about mammograms, they got to watch 41-year-old presenter Samantha Armytage actually having one.

Another episode featured co-presenter David Koch, age 61, undergoing screening for prostate cancer, including a PSA test and digital rectal examination.

“For blokes, it’s so important … you’ve got to get checked. You must get checked,” he told his co-hosts.

Time for a reality check, perhaps.

Australian guidelines are much less enthusiastic than “Kochie”, saying there is no evidence to support population screening with the PSA test.

Men considering the test need to be informed about the benefits and harms before making a decision, the guidelines say.

And digital rectal examinations are not recommended as a routine accompaniment to the PSA test, again due to a lack of evidence of benefit.

But, hey, this is television …

Armytage took a similarly cavalier approach. She acknowledged BreastScreen Australia guidelines recommending regular mammograms for women begin at age 50, but confidently declared: “I would say to start at 40, if you feel like it, if you want to.”

Well, of course, if you feel like it … Because who cares about evidence.

Not BreastScreen Victoria, apparently, who enthusiastically promoted the Sunrise hosts’ participation in these “important health checks”.

“With 1 in 8 women being diagnosed with breast cancer in their lifetime, it is a great way to bring awareness and take away the fear that is often associated with getting a breast screen,” says the organisation’s website, providing a link to “Watch Sam’s mammogram”.

You might expect better from BreastScreen Victoria, but the Sunrise team are hardly alone in thinking health screening must, by definition, be a good thing.

An anaesthetist I met at a dinner party a few years ago enthusiastically shared his recent colonoscopy experience with his fellow diners, advocating for the procedure to be included in routine colorectal cancer screening for the over 50s.

When I asked what the evidence to support such an approach would be, he replied: “I’m the evidence. It saved my life.”

I mumbled something about risk–benefit analyses, but he wasn’t having any of it.

For the record, Australian guidelines do not recommend colonoscopy for asymptomatic people at average risk of colorectal cancer.

The fear of undetected cancer blazes bright for many of us, and that can make the risks posed by screening seem insignificant by comparison.

Looked at on a population level, though, they are anything but, as epidemiologist Professor Alexandra Barratt spelled out in response to the Sunrise campaign.

“Unfortunately, Channel 7’s misguided advice on breast screening ignores vast amounts of independent medical research about the downsides of cancer screening tests,” she wrote in the Sydney Morning Herald.

“It may surprise most people to learn that screening tests can lead to ‘overdiagnosis’: the detection of cancers that are so slow growing, they will never cause symptoms or death and are better left alone … screening healthy women in their 40s [for breast cancer] is more likely to harm than save lives.”

Potential harms of any screening include anxiety and emotional upheaval as well as unnecessary treatment, with all the unwanted side-effects that might bring. Without clear evidence of benefit, it’s just not worth the risk.

Such nuanced messages can be hard to convey, though, when you’re up against the spectre of cancer.

And they definitely don’t offer the entertainment value of watching a popular TV presenter get a mammogram.

Jane McCredie is a health and science writer based in Sydney.

 

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