NFL Pink: A Not So Crucial Catch

This past weekend, the National Football League launched its annual month-long breast cancer awareness campaign, "A Crucial Catch: Annual Screening Saves Lives." Team logos incorporated splashes of "Susan G. Komen pink," pink ribbons encircled the NFL logo, and players, coaches and referees sported pink game apparel (which will be auctioned off as a fundraiser for the American Cancer Society).

According to the NFL, the chief purpose of the campaign is to raise public awareness of "the importance of annual [breast cancer] screenings, especially for women who are 40 and older." But there's a problem with that: annual screenings may not be good for many women under age 50, according to the United States' top science review board for medical screening.

The U.S. Preventive Services Task Force (USPSTF) is a government-established board of 16 doctors and scientists responsible for reviewing empirical research on preventive practices. The USPSTF is supposed to recommend preventive practices that the research indicates are worthwhile, and discourage practices that the research indicates are not helpful, and may even be harmful.

In 2009, the USPSTF released a much anticipated, exhaustively researched set of guidelines on mammography and other breast cancer detection practices for women. Previously, the task force had recommended that women over age 40 undergo a mammogram every two years. However, the 2009 report backtracked on that advice, stating that the medical evidence did not support screening for women 40–49. The report concluded that screening offered both potential benefits and harms, and that the cost/benefit calculus for women varied depending on their individual circumstances.

What harms could come from screening? Besides exposing women to (very low) doses of radiation, screening is physically uncomfortable and waiting for results can be emotionally taxing. False positives (where the test indicates cancer when in fact it isn't present) do occur and result in emotional distress and sometimes even painful and costly "overtreatment." Also, false negatives (where the test indicates no cancer when it is present) may cause women to discount symptoms of cancer, reasoning that "My last mammogram was fine."

After weighing the medical concerns (the task force did not consider the financial cost of screening in its analysis) against the benefits of early detection, the USPSTF withdrew its general recommendation of mammography screening for asymptomatic women under 50. (It does continue to recommend biennial screening for women ages 50–75, but discourages screening for women over 75.)

The NFL's Crucial Catch campaign is not the only sports league public awareness campaign that clashes with medical science. In November, the National Hockey League and its Players Association participate in the "Movember" campaign, with players growing (often outlandish) mustaches to promote "men's health" issues. Prominent among those issues is prostate cancer, and the promotion of prostate cancer testing including prostate-specific antigen (PSA) screening.

In 2011, the USPSTF released its guidelines on PSA screening that recommended asymptomatic men not undergo the tests.

Washington Capitals defenseman Karl Alzner sports a
Movember mustache. (ESPN)

Several concerns factored into that recommendation. One is that there is little evidence that early detection of prostate cancer increases the patient’s likelihood of surviving the disease.

Another reason is that most of the instances of prostate cancer identified by PSA tests prove to be insignificant to the patient’s health (because the cancer is de facto benign)—yet many patients undergo treatment anyway. Prostate cancer treatment is not only costly and unpleasant, it is also risky. About half of men who undergo prostate-removal surgery experience sexual dysfunction; a third have urination problems; and between one and two in a thousand die as a result of iatrogenesis—harm caused by the medical care they receive. Men who undergo radiation treatment also risk impotency and urinary problems (at lower rates than surgery) and 15 percent suffer radiation damage to the rectum, resulting in “moderate or big problems.”

Unsurprisingly, the USPSTF recommendations on mammograms and PSA testing generated a storm of controversy, including political action to prevent health insurers from acting in accordance with the USPSTF guidelines. Elsewhere, I've written about the potential effect such politics will have on the 2009 Patient Protection and Affordable Care Act (sometimes called "Obamacare") and its establishment of a quasi-successor to the USPSTF, the Independent Payment Advisory Board.

The NFL, NHL, and their players deserve credit for trying to improve women's and men's health. But pink ribbons and mustaches are not enough; if the leagues really want to promote health, they should encourage their fans to carefully discuss the USPSTF recommendations with their doctors.