‘This is a major breakthrough:’ PR release on rapid MRI for dense breasts exemplifies why news stories need independent sources

Kathlyn Stone is an associate editor with HealthNewsReview.org. She tweets as @katkstone.

One of the most important tenets of strong journalism is independent sourcing. The inclusion of outside sources is part of what separates real news from PR news releases.

rapid MRI for dense breastsThat’s why, when a news release with the boastful headline “New breast screening method to save thousands of women from cancer” hit my in-box, I quickly scanned it to see if it provided numbers to back up the claims that screening will “save thousands,” and if it included any limitations on the research and the potential harms from screening tests. It didn’t.

The one-source release was from a medical imaging center that has a promotional interest in this issue. The release was about “rapid MRI” and how it reduces the time it takes to detect breast cancer in dense breasts (and thus makes it more affordable and accessible to more women). But the superficial document didn’t answer any of the core questions readers would surely ask.

It ended as boastful as it started, quoting the researcher behind the project: “This is a major breakthrough. I can see a day when we can prevent this disease from killing women.”

That’s a statement that could resonate with a lot of women. Approximately 12.4% of U.S. women will develop breast cancer sometime in their lifetime, and about 10% will die from the disease, according to the National Cancer Institute.

The release no doubt launched this very glowing one-source article from Consumer Affairs. (CA is a for-profit “web-based consumer news and resource center,” that accepts member fees from the companies being reviewed. It is not affiliated with Consumer Reports.) More news outlets like Imaging Technology News, Science Daily and MedicalXPress ran the release just about verbatim.

Why sources matter: Experts shed light on claims being made

Any news story can be improved with inclusion of outside sources. To illustrate this, I turned to three of our HealthNewsReview.org expert reviewers–each one with expertise in evaluating breast cancer research.

Dr. Deanna Attai is a breast cancer surgeon at UCLA and past president of the American Society of Breast Surgeons. She was familiar with the concept of rapid MRI technology, having attended a presentation on it at a medical meeting in 2015.

The first thing she noted about the release was the claim that this technology will reduce deaths from breast cancer. She found this problematic, especially when accompanied by the researcher’s statement about seeing “a day when we can prevent this disease from killing women.”

“This implies that early detection will lead to cures in all cases when we know it is just not that simple,” Attai said. “Some breast cancers, no matter how early they are detected, will be fatal.”

She also pointed out the release doesn’t mention one of the top drawbacks of using MRI for breast cancer screening: While it may be better at detecting tumors and suspicious tissue areas, it also has fairly high false-positive rates.

“This results in additional imaging, such as second-look ultrasound and often biopsy and/or 6-month follow up. We accept that high false-positive rate in high-risk women — but the high false-positive rate is one reason that we do not recommend MRI for screening of average-risk women,” she said.

Another concern not addressed is the availability of rapid MRI.

“I do not have any facilities in my area [greater Los Angeles] that have publicized rapid MRI and in discussions with my breast surgery colleagues, I don’t get the sense it’s widely available,” Attai added.

‘Women deserve better than this’

Christine Norton, president and co-founder of the Minnesota Breast Cancer Coalition and a breast cancer survivor, thought the release relied too much on fear-mongering. The headline plays on people’s “understandable efforts to get the most accurate screening possible,” she said. But it didn’t touch on the number of false positives associated with the rapid MRI screening, nor the stress and costs of any follow-up tests resulting from a false positive.

“While dense breasts are a risk factor for breast cancer, the mortality rate is not higher for women with dense breasts,” she said. “To be blunt — it’s the mortality rate that people should focus on with this type of screening that will also generate more false positives.”

Mandy Stahre, PhD is a senior research analyst at the Washington State Office of Financial Management and program manager for the Washington State All-Payer Health Care Claims Database. She’s also a breast cancer survivor.

Stahre took exception to calling rapid MRI “new.” It’s more a change in protocol on how MRIs are read and how the images are captured. Instead of the MRI capturing the entire tissue area, it focuses on certain areas of the breast.

“I think the claims are a little overblown,” she said, pointing out that it’s based on one study that found 7 malignancies. The study wasn’t clear whether the total number of malignancies found also included three instances of ductal carcinoma in situ (DCIS), she said.

DCIS indicates the presence of abnormal cells that haven’t spread beyond the milk ducts and may never do so. Many experts are reluctant to refer to it as cancer.

The science is most definitely unsettled

The study included volunteers who had a mammogram in the past 30 days. It was not a randomized controlled trial and it only conducted one MRI with no follow-up for any of the women (except those that went on to have a biopsy because the MRI detected something).

“Without any follow-up, we do not know if the women who had the abbreviated protocol for MRI had better outcomes than women whose breast cancer was detected with mammogram,” she said.

Stahre also said the claim that women would only require screening every two years was unfounded. “The study did not test any theory that women would only need to do an MRI once every two years to detect breast cancer.”

Nor was the study replicated by other researchers.

“Any claim that the new technique will save lives is unsubstantiated–unless there is follow-up of the study participants and a randomized controlled trial has been conducted with the new protocol,” Stahre says. “And even then, we won’t know for years whether a technique or method actually saves lives.”

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Mark Ebell MD, MS

March 6, 2017 at 11:29 am

Stats above that you cite are misleading. The 12.4% lifetime prevalence is only for women that live to be 80 years old (not all do). Someone living to be only 60, for example, has a much lower lifetime risk. Also, in an unscreened population, 3.0% of women die of breast cancer, not the 10% you cite. That drops to 2.2% – 2.3% with regular guideline recommended screening.