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Any doctor involved with breast cancer is perhaps more likely than specialists in other fields to be faced with the opportunity to talk to the press. As medical specialties go, breast cancer is among the top in generating news. For at least 4 decades, breast cancer has generated interest both for advances in the field and human stories. This chapter seeks to explore some of the issues in breast cancer that received the greatest news coverage. It also attempts to critically examine how the press handled different stories and to offer some guidance on how doctors should and should not respond to the media and to the new world of Internet news. More than ever, doctors who treat breast cancer will be faced with patients who bring with them information from a wide range of sources. It is important for doctors to better understand how these media outlets approach their field.

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On March 17, 1999, 3 trials comparing high-dose chemotherapy with autologous bone marrow transplant (HDC/ABMT) and standard chemotherapy were presented at the annual meeting of the American Society of Clinical Oncology.1 The 3 trials showed no difference in overall survival between the 2 treatments.

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On November 30, 1995, the New England Journal of Medicine reported on the reanalysis and results after 12 years of follow-up in a randomized clinical trial comparing total mastectomy with lumpectomy with or without irradiation in the treatment of breast cancer by Fisher and associates.2 The study found that "lumpectomy followed by breast irradiation is appropriate therapy for women with either negative or positive axillary nodes and breast tumors 4 cm or less in diameter."

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On August 6, 2002, the largest study ever to look for environmental links to breast cancer, involving 1000 women from Long Island, found that the data, "based on the largest number of samples analyzed to date among primarily white women, do not support the hypothesis that organochlorines increase breast cancer risk among Long Island women."3

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Each of these studies provided an important turning point in the news coverage of these issues that ultimately turned out to be wrong. The media in each case created an impression that the story was different.

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In the case of a controversial HDC/ABMT treatment, the media had done numerous stories suggesting that HDC/ABMT was the last hope for women with breast cancer, and that health plans that denied the treatment were more interested in profits than women's lives. In the case of scientific misconduct, the public heard suggestions in news reports that the National Surgical Breast and Bowel Project (NSABP) studies, which concluded that lumpectomy was as effective as modified radical mastectomy, might have the results called into question because of scientific misconduct involving patients entered into the trial by one Dr Roger Poisson. And in the example of the environmental role in breast cancer risk, patient advocates and politicians regularly made their case ...

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