This morning TV news segment on transnasal endoscopy promises a live, in-studio demonstration of a new, one-minute test that can save lives from a little-known epidemic cancer.
Great story–but, alas, not true.
The device demonstrated, the TNE, has been the subject of research for nearly a decade and has been in clinical use for several years.
Its chief advantage appears to be that it does not require anesthesia, not that it detects cancer more accurately.
The cancer is rare and deadly, killing over 85 percent of patients within 5 years of diagnosis, even with early intervention and treatment.
Over 99 percent of patients who are diagnosed with the precursor condition, Barrett’s esophagus, do not go on to develop cancer.
The test takes not one minute but, in the live demonstration, at least 5 mintues. Some published materials claim the test can take about 10 minutes. But the one-minute claim appears to be a Good Morning America exclusive.
So what is new here? We do get to see a guy wearing a suit having a thin tube run up his nose and into his stomach without gagging, all while we get to view his innards live onscreen. Not bad for the morning news. Plus, people who for whatever reason may be facing a conventional upper endoscopy will benefit from learning about this sedation-free alternative.
But none of this excuses the segment’s theatrical bravado, intellectual negligence and poor journalistic hygiene. How do things like this wind up on the air?
The segment fails to report how much the transnasal endoscopy costs, how much the device itself costs, or whether insurance pays for it.
As it happens, it appears the TNE costs considerably less than standard endoscopy–$500, as quoted in a 2007 article, vs. $3,000–due to the fact that anesthesia is unnecessary. However, that raises a health policy issue that needs to be considered. The widespread availability of a relatively benign office based test could result in widespread adoption and overuse could overwhelm any individual patient savings.
All of this would have been useful to mention.
The host makes a game attempt to verify the benefits of TNE:
"But you have a procedure, and again, this can detect Barrett’s very early so you can be watching it, make changes that could eventually even prevent half of these cancers?"
To his credit, the physican declines to respond affirmatively.
Still, the story fails to make the case that TNE can increase early detection, or that early detection will lead to reduced mortality. The role of TNE in the management of patients with symptoms of GERD is unclear at the present time. Less than 1% of people with Barrett’s will go on to develop esophageal cancer.
The doctor doing the procedure live says there are no risks; the network’s medical editor says there may be some throat irritation afterwards.
The literature does suggest that risks of complications are very low, especially compared to the risks of the conventional procedure done under sedation.
But the procedure carries small risks of nosebleeds and vomiting. About 5 percent of patients in early research could not complete the procedure due to discomfort or anxiety. Very rarely, the esophagus is punctured or injured.
As with any diagnostic procedure, TNE carries risks of misdiagnosis and unnecessary, ineffective and harmful treatment. These risks are especially true with Barrett esophagus, since the condition usually does not turn into cancer. Researchers are trying to determine which cases are most necessary to treat, but at this point they do not know.
The story presents no evidence demonstrating the TNE is effective or safe.
The segment repeatedly exaggerates the prevalence of esophageal cancer, confuses it with Barrett esophagus, and incorrectly implies a life-saving test has just been introduced.
At the opening, the segment says esophageal cancer is "one of the fastest growing cancers" in the U.S., with the "rate of new cases increasing 400 to 500 percent per year."
It’s hard to know what’s meant by this. The number of new diagnoses is certainly not quadrupling or quintupling each year. If we assume the diction is correct–that the rate of increase in new cases is 400 to 500 percent per year–that’s an odd statistic to use. One fears it is being cited because it sounds scary, not because it helps put the cancer in perspective.
The same can be said for the statement that esophageal cancer is "twice as deadly" as melanoma. It’s not clear what’s being compared or why this comparison matters.
The story also overstates the link between Barrett’s esophagus and esophageal cancer. The host says "fully [sic] half of the cases may be related to the nation’s growing problem with acid reflux," though the American Cancer Society estimates the number at 30 percent.
The segment correctly indicates that reflux can lead to Barrett’s esophagus which in turn can lead to esophageal cancer. But NIH says about 1 percent of adults may have Barrett’s esophagus. Of these, the American Cancer Society estimates, one half of 1 percent are diagnosed with esophageal cancer each year.
The host leads the piece with what she calls "a very big headline" about health, that there is "a test" that can "help thousands" avoid cancer. She encourages viewers to "gather everyone you know and join around this morning" and learn about the test.
They are likely to be disappointed. TNE is not new; it is a fairly recent improvement to a diagnostic test that’s been available for years. It is not proven to detect more cases of Barrett’s or cancer. There is no new treatment for the disease, and the risk factors are well known.
And finally, the host says the TNE takes "one minute." The tube hits the patient’s nose at 3:42 of the segment, and isn’t removed until about 8:45. That’s at least 5 minutes. What gives?
There is not a truly independent source here. The producers should have interviewed a disinterested ENT who could put the transnasal method in context, and discuss what is known about early detection and treatment of Barrett and esophageal cancer.
The segment should have plainly laid out the differences in risks and benefits of conventional vs. transnasal endoscopy.
There is some controversy about the appropriate approach to following patients with GERD or GERD-like symptoms. The piece should also have mentioned other diagnostic techniques, including barium X-rays, CT scans and ultrasound.
The segment fails to make clear where the TNE procedure is available.
TNE has been studied extensively and has been in clincial use for several years.
The story fails to report this; in fact, it implies otherwise.
There does not appear to be a press release linked to this broadcast.