Views & Reviews No Holds Barred

Why the Sun’s breast check campaign may actually harm women

BMJ 2014; 348 doi: http://dx.doi.org/10.1136/bmj.g2447 (Published 01 April 2014) Cite this as: BMJ 2014;348:g2447
  1. Margaret McCartney, general practitioner, Glasgow
  1. margaret@margaretmccartney.com

It’s “Page 3 v breast cancer,” sang the Sun’s front page, accompanied by a young woman naked apart from knickers, hand on mammary, to launch its “check ’em Tuesday” campaign.

The newspaper, keen to shift attention from widespread calls for it to scrap topless women on Page 3, will include a weekly call for women to examine their breasts and asks readers to send in photos to prove compliance. Readers can sign up for a text message reminder.

By page 3, though, the regular spot for the topless female, one of the cover model’s nipples had slipped out. Yes, it’s the same Sun, and even the founder of the campaign No More Page 3 has said that “it would be churlish to wish the campaign anything other than success.”1

Apologies, but here comes the churlishness. Teaching women to examine their breasts regularly has been shown not to reduce deaths from breast cancer and actually increases the chances of a benign biopsy result.2 3 It is unfair to tell women that regular self examination will save their lives when it may simply incur anxiety and have the potential to harm. Sound bites, beyond the safety of scientific qualification, can denature evidence.

This is just one aspect of a bigger move to promote untested “breast awareness.” The charity Breakthrough Breast Cancer, which is not connected to the Sun’s campaign, tells women to “touch, look, feel” regularly and advocates “knowing what your breasts look and feel like normally” as well as being able to name “the 5 signs of breast cancer.”4 NHS Choices suggests that women should examine their breasts at different times of the month in the shower or bath and lists nine changes to “look out for” and to “look and feel.”5 The charity CoppaFeel, which is involved with the Sun’s campaign, offers text message reminders to prompt women to do a regular self examination.6

The reason for so much confusion is the lack of acknowledgment of the current uncertainty.7 Yet it would be possible to run a randomised trial to see whether promoting “breast awareness” has benefits and what it should consist of.

Publicity campaigns that claim to be “against cancer” seem to get past much critical challenge, to our collective disadvantage. Public health messages should be based on evidence. Their effects need to be proved to affect behaviour in a way that is helpful and not harmful. When medicine mixes with public relations and media campaigns, citizens and patients risk being short changed because their interests are vastly different.

If we fail to critically evaluate campaigns on cancer, we create the appearance of doing something useful while potentially distracting from what might really help. In doing so we potentially harm the very women we’re purporting to help. The Sun’s primary interest is in selling papers; so what are the charities’ and the NHS’s excuses?

Notes

Cite this as: BMJ 2014;348:g2447

Footnotes

  • Competing interests: I have read and understood the BMJ Group policy on declaration of interests and declare the following interests: I’m an NHS general practice partner, with income partly dependent on Quality and Outcomes Framework points. I’m a part time undergraduate tutor at the University of Glasgow. I’ve authored a book and earned from broadcast and written freelance journalism. I’m unpaid patron of Healthwatch. I make a monthly donation to Keep Our NHS Public. I’m a member of MedAct. I’m occasionally paid for time, travel, and accomodation to give talks or have locum fees paid to allow me to give talks but never by any drug or public relations company. I was elected to the national council of the Royal College of General Practitioners in 2013.

  • Provenance and peer review: Commissioned; not externally peer reviewed.

  • Follow Margaret McCartney on Twitter, @mgtmccartney

  • Find out more about the doctor behind the column: read Margaret McCartney’s recent BMJ Confidential, “Singing the praises of evidence,” www.bmj.com/content/348/bmj.g2015.

References