3. Breast Cancer Detection in Passive Voice

One symptom of medicus incomprehensibilis is passive voice. Passive voice means that the subject of the sentence receives the action rather than doing the action. Passive voice can be a useful writing technique, but it works best when you use it sparingly. Sometimes, it can make a sentence sound vague, wordy or abstract. Medical writing tends to overuse passive voice.
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For this post, we look at an excerpt from an article published in The Journal of the American Medical Association(1) that uses three sentences in passive voice and one in active voice. We underlined the words in each sentence that make it passive.

Mammograms from women attending routine breast cancer screening at these centers during the study period were included. These were arranged into batches of approximately 40 women pursuant to standard practice in the United Kingdom. All mammograms taken during the study period were included in the trial, regardless of when they were examined. Each batch contained all cases from a single mammography acquisition machine in a single day. (WSEG = 67/16.7/ 35.7/12.5)

N​ote that the first and third sentences both say that mammograms … were included. The mammograms didn’t do anything. Instead, somebody did something with them. 

Passive voice often involves a form of the verb to be plus a past particle. The first sentence uses the word were, the past tense of to be, and included, the past participle of to include. In the second and third sentences, the words, were arranged, were included, and were examined show they also use passive voice. 
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Can we revise the excerpt to improve reading ease? The only special terms we see are mammogram and mammography, and they are commonly understood. Therefore, we think we can probably revise to improve reading ease. 

Our Revision

Here is our attempt to revise the excerpt to use less passive voice and improve reading ease.

Original

Revised​

Mammograms from women attending routine breast cancer screening at these centers during the study period were included. These were arranged into batches of approximately 40 women pursuant to standard practice in the United Kingdom. All mammograms taken during the study period were included in the trial, regardless of when they were examined. Each batch contained all cases from a single mammography acquisition machine in a single day. (WSEG= 67/16.7/35.7/12.5)

The trial used the mammograms from women who came for routine breast cancer screening at the centers. It covered mammograms taken during the study period without regard to when they were read. They were arranged into batches of about 40 women under UK standard practice. Each batch contained all mammograms from one machine for one day. ​(WSEG = 56/14.0/61.6/8.2)

​In our revision, only the third sentence has its main clause in passive voice (i.e., they were arranged). The second sentence also uses a dependent clause in passive voice (i.e., they were read). We did this to keep a consistent subject with the previous sentence.
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Is this a good paraphrase of the original? Do you find it easier to grasp? Perhaps, you can think of a better way to say the same thing.

Comparing WSEG Scores

Let’s compare WSEG scores for the original and our revised version.

WSEG	Meaning	Original	Revised	Change
W	Total words	67	56	-11
S	Average sentence length	16.7	14.0	-2.7
E	Flesch reading ease	35.7	61.6	25.9
G	Flesch-Kincaid grade level	12.5	8.2	-4.3

These data show a reader would likely find the revision easier to read. If the whole article were revised in plain English, it could reach a wider audience.

Conclusion

In this post, we looked at an excerpt that used passive voice—one symptom of medicus incomprehensibilis. We showed how we would revise to use less passive voice and make it easier to read. We talk about passive voice in Chapter 4 of Plain English for Doctors and Other Medical Scientists (Oxford University Press, Spring 2017).

This post is third in a series on Symptoms of Medicus Incomprehensibilis. 
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(1) Taylor-Phillips S, et al. “Effect of Using the Same vs Different Order for Second Readings of Screening Mammograms on Rates of Breast Cancer Detection: A Randomized Clinical Trial,” JAMA 315, no. 18 (2016): 1957.