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[CHANGE IN HEALTHCARE UTILIZATION FOLLOWING DOCUMENTARY TV PROGRAM ABOUT YOUNG BREAST CANCER PATIENTS].

BACKGROUND
Personal decision-making concerning health can be heavily influenced by the way mass media conveys health messages and news. Research has shown that there is a connection between health news publications and changes in healthcare utilization, not always for the better. In March 2014 a program about young breast cancer patients was broadcasted as part of the popular Israeli documentary TV series "Uvda" (fact), which gained a lot of publicity. We examined whether there is a connection between the controversial program and changes in healthcare utilization in the field of breast cancer detection in Maccabi, the second largest HMO in Israel.


METHODS
We conducted a retrospective large data population-based study, using Interrupted Time Series Design. Trends in healthcare utilization were examined starting 3 years prior to until one year after the TV program. All Maccabi female patients aged 20 to 74 were included after receiving the approval of the Institutional Review Board (IRB) committee. The rate of doctors' visits, mammography and breast ultrasound referrals were examined, as well as actual performance of these tests. Socio-demographic parameters of patients and referring doctors were analyzed. The data was extracted from the Maccabi computerized database and analysed using SPSS software version 21, controlled for seasonality.


RESULTS
Data was available for 656,581 female patients from January 2011 until June 2015. A surge in mammography referral rates was shown following the TV program about young female breast cancer patients, especially concerning young patients referred to their first mammography scan. The proportion of young women, among all women referred to mammography, doubled in the specific quartile the program was broadcast. A similar trend was shown for the actual performance of mammography scans. We did not find a significant surge in doctors' visits following the TV program, beyond the background trend of increasing visit rates over the years studied.


CONCLUSIONS
Although causality cannot be proven, we can speculate that changes in healthcare services utilization in the field of breast cancer detection among young female patients were partly connected to the effects of the TV show on this issue. These effects can have serious implications on health, including anxiety, false positive test results and over-diagnosis of breast cancer. Therefore, there is a need to find ways to cooperate with the mass media professionals in order to convey to the public more correct and balanced health data in a way that will be better understood. Thereby, we can fulfill our mission of raising the level of public health in the era of rising costs.