In the late 1990s, 3 events pertaining to breast cancer prevention received
considerable attention in the US news media: a National Institutes of Health
(NIH) consensus panel recommended against routine screening mammography for
women in their 40s (January 1997), the National Cancer Institute (NCI) subsequently
reversed the recommendation (March 1997), and an NCI-sponsored study demonstrated
the efficacy of tamoxifen in the primary prevention of breast cancer (April
To examine how the major US news media covered the potential benefits
and harms of 2 breast cancer preventive strategies.
Design and Setting
Content analysis of US news stories reporting on the breast cancer prevention
events. We used Lexis-Nexis to search for print news stories in the 10 highest-circulation
US newspapers and requested transcripts from 3 major television networks to
obtain all relevant news coverage in the 2 weeks following each event.
Main Outcome Measures
Attitude toward preventive strategy (encourage, neutral, discourage);
level of uncertainty about benefit and how benefits and harms were presented.
Twenty-seven stories about the NIH consensus panel, 24 about the NCI
reversal, and 34 about tamoxifen appeared in high-profile news media within
2 weeks of each event. Sixty-seven percent of NIH consensus panel stories
left the impression that there was a lot of uncertainty about whether women
aged 40 to 49 years should undergo screening, but 59% suggested that women
should probably or definitely be screened. Only 4 stories suggested that women
faced a genuine decision about what to do. The level of uncertainty reported
was substantially lower following the NCI reversal (21% suggested a lot of
uncertainty), and most stories (96%) suggested that women should be screened.
In contrast, tamoxifen stories highlighted uncertainty about what women at
high risk should do (62% suggested there was a lot of uncertainty), and none
left the impression that women should definitely take the drug (24% suggested
they probably should). Sixty-five percent of these stories suggested that
women faced a genuine choice and would have to weigh the risks and benefits
Most news stories favored routine use of screening mammography and urged
caution about using tamoxifen. Almost all noted the potential harms of each
preventive strategy; however, the negative aspects of tamoxifen received greater
emphasis. Whereas taking tamoxifen was presented as a difficult decision,
having a mammogram was presented as something women ought to do.