Does the Internet tell women what they should know about screening mammography?
That question prompted Karsten Juhl Jorgensen, M.D., and Peter Gotzsche, M.D., to draw up a checklist of 17 informational items that covered the possible benefits of screening and what they classified as its "possible harms." The researchers, both at the Cochrane Collaborations Danish Center, which Gotzsche heads, then applied the checklist to 27 Web sites that purported to offer authoritative screening information to the general public.
The sites in question were based either in Denmark, Norway, Sweden, Australia, Canada, New Zealand, the United Kingdom, or the United States. Some spoke for governmental institutions, others for professional advocacy organizationscancer nonprofits, for exampleand still others by what Gotzsche and Jorgensen styled consumer groups. All the sites were accessed during September and October 2002.
Writing in the January 17 issue of the British Medical Journal, the authors gave poor marks to the advocacy group and governmental organizations Web sites, saying that they tend to favor "information ... that shed positive light on screening" (some of it inaccurate or misleading) while minimizingindeed often failing to even mentionsuch risks as overdiagnosis and overtreatment that the examinations can confer.
Among the things the authors found fault with in these sites was that they typically said that screening reduces the chance of breast cancer death by a specific amount (usually 30%) without making it clear that this is a reduction in relative risk or without explaining what relative risk means. Also potentially misleading, the authors said, was the tendency of these sites to soft-pedalor simply ignorethe injuries that breast cancer treatments can inflict.
The consumer group Web sites, by contrast, largely avoided these pitfalls, especially if their parent organizations accepted no industry funding (or severely restricted it) and, unlike governmentally endorsed programs, were not committed to the view that virtually all women of certain ages should be screened.
Gotzsche and Jorgensen reported that the Web site of the Center for Medical Consumers in New York (http://www.medicalconsumers.org) fared best of all, meeting 13 of the 17 criteria on their checklist.
Related News Article in JNCI
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