NYT column looks at women's decisions about tamoxifen

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It’s noteworthy when news stories look closely at the decision-making approaches that patients employ.

Case in point: a New York Times column on a study of 632 women whose five-year breast cancer risk projections might seem to make them leading candidates to take the drug tamoxifen.


“Virtually every woman in the study said she would be unlikely to take the drug. Just 6 percent said they would consider it after talking to their doctors, and only 1 percent reported actually filling a prescription for it. Fully 80 percent cited worries about side effects.

“When the numbers were laid out for them in a way they could clearly understand, they weren’t interested in taking tamoxifen,” said Angela Fagerlin, associate professor of internal medicine at the University of Michigan and the lead author of the study, published in the journal Breast Cancer Research and Treatment. “They didn’t think the benefits of tamoxifen outweighed the risks.”

The column suggests that these reactions surprise and concern some doctors and researchers.

But look at how the story itself was framed in the opening lines:

“If someone invented a pill to cut a cancer risk in half, would you take it? Who wouldn’t? Apparently the answer is millions of women.”

If these women were fully informed about benefits and harms of tamoxifen, then they learned that “cut in half” is a relative risk reduction figure. Half of what? According to the story, it’s a reduction from 19 breast cancer cases over 5 years in 1,000 women down to 10 cases. Or an absolute risk reduction from about 2 percent down to 1 percent.

We have much to learn about how people process risk reduction figures. But one thing journalists must learn is that absolute risk reduction figures are far more helpful to readers and patients and consumers than the more impressive-sounding relative risk reduction figures.

See our primer on this topic.

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