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Getting facts straight on ovary removal/breast surgery story

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Journalist Andrew Holtz has been a colleague for longer than probably either one of us wants to remember. He is currently one of our story reviewers on HealthNewsReview.org. In fact, he was one of the reviewers on four stories we analyzed last week on the same study. He thought there were some important take-home messages that rose above the walls of our formal, systematic review, so he wrote this guest blog post, and we thank him for it.

The Sept. 1 issue of the Journal of the American Medical Association included an article that is likely to have a strong influence on the advice given to women who have a very high risk of breast and ovarian cancer linked to mutations of the BRCA1 and BRCA2 genes. Of the four stories we reviewed, only the AP report scored well on our review criteria.

I know what my first journalism professor, Marion Lewenstein, would have done with at least two of the stories: given them an F for factual errors without further consideration of their merits.

The NPR story stated that the study “tracked nearly 2,500 women with the BRCA mutations who had surgery to try to prevent breast and ovarian cancer.” (emphasis added) While the study did indeed include nearly 2,500 women with BRCA mutations, 38 percent had their ovaries removed and only 10 percent had preventive mastectomies. The Reuters report not only committed the same error in describing the participants in the study, it also confused the relative risk of cancer with the women’s lifetime risk. For instance, the story said, “Women with mutations in the BRCA1 or BRCA2 genes have a 56 to 84 percent higher risk of developing breast cancer during their lifetimes.” (emphasis added) Actually, those figures are estimates of the absolute lifetime risk; that is, half to more than three-quarters of these women would be expected to develop breast cancer. That risk is several times higher than the commonly quoted figure of a 12 percent lifetime risk for women in general.

It is hard to put much faith in the rest of the reporting when a story contains such blatant errors. The news organizations should not only publish corrections, but also review their procedures to reduce the likelihood of such embarrassing gaffes.

The stories also included some troubling quotes. While journalists are not always experts, we have a responsibility to do the best we can to evaluate what experts tell us and put the quotes in context with other information.

The NPR story included a quote from a researcher that claimed mastectomy reduced the risk of death. That’s not what the study reported. Women who had their ovaries removed were less likely to develop cancer and less likely to die. The women who had their breasts removed did not develop breast cancer during the study period, but there was nothing in the study about mastectomy reducing the risk of death. Even if the expert said the words, the reporter should have known that the study did not report that finding.

The Reuters story also failed readers by allowing an expert to urge (without any challenge or context) “all women with a family history of early breast cancer” to have genetic testing. That advice goes far beyond what other experts say. It is quite easy to look up an online risk calculator that will tell you that less than 3 percent of women who have a single relative who had early breast cancer carry the BRCA gene mutations. That prevalence is only 1 percent higher than that among women with no family history of breast or ovarian cancer. (The rates for women of Ashkenazi heritage are higher.) Why would gene testing not be routinely recommended for women with no known risk factors (and a 1.5 percent risk of carrying a BRCA mutation), but then if the risk rises to 2.6 percent, suddenly testing should be universal? The reporter should have asked that question and given readers at least some of the background.

This study of cancer genetics and preventive surgery is newsworthy. All of the news organizations that covered it should have invested the care, attention and skill shown by the AP.

– by Andrew Holtz.

We welcome any comments on our story reviews, or on Holtz’s guest post.

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Comments

Please note, comments are no longer published through this website. All previously made comments are still archived and available for viewing through select posts.

Maggie Fox

September 17, 2010 at 6:09 pm

Wow I have just seen your Sept. 7 post on our Aug 31 story on breast removal and cancer risk.
I was horrified and immediately checked the story, filed by a veteran health reporter on my team, and find that while the review makes some valid points, it also contains some inaccuracies and uses some partial quotes out of context.
We did err on how many women in the study had surgery and corrected that in our story the next day, but your review does not note that.
We do not quote the researchers as urging all women to have the test. We quote them as saying primary care physicians, gynecologists and women should be aware that the test exists. We are then careful to include a quote saying: this is not cookie cutter medicine and mention more than once that this would be “a difficult choice” to make.
The review is right about the mistake in lifetime risks of breast cancer and we’ll correct that – thanks for pointing it out.
One advantage bloggers have over journalists is they don’t have to take the time and effort to call and talk to the people they are writing about. Do as I say, not as I do?
It may be useful to realize that while Reuters stories are sometimes distributed to a general audience, our main client base goes far beyond the general public and as an international news organization we are definitely not writing for a US-central audience.
I applaud your mission in holding health journalists accountable for what they write and for pushing for accuracy. We hold ourselves to a high standard, also, and appreciate the opportunity to reply.
I might suggest that encouragement and a positive approach, in general, works well in raising standards. In reading back over some of your posts I am a bit surprised by the tone.
Thanks so much.
Maggie Fox
Editor in charge
Health and Science
Reuters

Gary Schwitzer

September 17, 2010 at 8:14 pm

Maggie,
Thanks for your note.
We review the story as we find it online on the date we find it. We can’t possibly keep up with every correction you might post later. (Many readers will never see such a correction, either.) So if the error occurred in the original story, that’s what we saw and that’s what we reviewed.
We notify someone from every news organization whenever a story is reviewed. Reuters has been reviewed 51 times in the past 9 months, so there have been plenty of opportunities before this to see what we were writing about.
Does your suggestion that Reuters – as an international news organization that is “definitely not writing for a US-central audience” – imply that readers elsewhere deserve a lower standard of journalism? Otherwise, I’m not sure I see your point.
You apparently felt that we don’t use “encouragement” or a “positive approach” and said you were “surprised” by our “tone.” Please tell me how that’s missing in some of these excerpts of past reviews of Reuters stories:
• “Reuters Health digs deep and wide on this one, affords the story a lot of space, and delivers readers a very good story.”
• “A balanced, cautious story that earns a four-star score”
• “This was a fine piece of journalism”
• “A refreshingly restrained take on a new observational study of vitamin E and the risk of dementia. The story maintained a cautious tone throughout and never slipped into the “may reduce risk” language so prevalent in other reports of observational studies.”
• “thorough and well balanced”
• “We see so many stories that make unfounded claims about observational studies. It is refreshing to see one that put findings in perspective so well.”
• “A rare story that appropriately focuses on the downsides of an expensive medical procedure!”
You may choose to focus on a review you didn’t like. We prefer – and always do – to shine a light on excellence when we see it. As I’ve just documented, we have pointed out many instances of excellence on Reuters. But we’re not going to shy away from constructive criticism when we see flaws. We’re pleased to see that you acknowledge at least some flaws in the story in question – a story that was reviewed by two journalists and by one health care expert.

Andrew Holtz

September 17, 2010 at 8:16 pm

Egad. I need to give myself an F.
It was the HealthDay story that included the quote urging women with a family history of early breast or ovarian cancer to undergo genetic testing.
However, the Reuters story does more than merely say women should be aware that the test exists. It paraphrases researchers thus: The study shows the benefits of genetic tests that give women with a family history of cancer the chance to take steps to increase their chances of survival, they said.
And the Reuters story also includes a quote from a doctor referring to “the importance of genetic testing when there is a family history of early breast or ovarian cancer.”
While these references are certainly not as extreme as the one in the HealthDay story, I expect most readers would take them to mean that any woman with a family history of breast cancer could “benefit” from genetic testing. But according to the online risk calculator from Myriad Genetics, the risk that a woman with a family history of early breast cancer (and no other risk factors) has a BRCA gene mutation is just 2.6% (only 1% higher than that of a woman with no family history of early breast cancer).
See http://www.myriadtests.com/index.php?page_id=165
This research is about women who have BRCA mutations. Having a family history of cancer is an entirely different situation.
Thank you, Maggie, for taking the time to check out the review and blog post… and calling me out for my error. To your point about talking to the reporters of the stories we review, I would just point out that the review looks only at what was published and how that story matches our criteria.
While I would note that the mis-identification of the source of that quote was confined to my blog post and did not play any role in the story review itself, I regret the error.
Andrew Holtz

Hilary Gerber

September 24, 2010 at 11:55 pm

I am a medical student who just finished two months of a surgery rotation with a practice that does a lot of breast cancer treatment. Their advice on genetic testing is that, preferably, the person WITH the early breast or any ovarian cancer should receive the genetic testing, not their so-far unaffected relatives. If they do not have the gene, then it is pointless for their relatives to go through the testing.
Thanks for your critique of the coverage of this and other medical journalism. Even physicians interpret the research wrong, according to research on physicians presenting evidence based risk to patients.

Marion Lewenstein

January 5, 2011 at 9:58 pm

Hi Andy: sorry you had to give yourself an F! Even so, enjoyed seeing you in print. I’m long past giving F’s myself; have been retired for the last 10 years.
Good luck.
Marion Lewenstein