Birth control pills & breast cancer risk: big study generates big differences in quality of news coverage

Michael Joyce is a writer-producer with and tweets as @mlmjoyce

Are the newer birth control pills of the past few decades safer  — at least regarding breast cancer risk —  than older oral contraceptives?

It’s a question doctors have been eager to study for some time. And this week a Danish study published in the New England Journal of Medicine provides some important, albeit observational, data.

If you heard about the study in a news story, you may have read or heard very different take-home messages than what other news consumers received from other news sources.

Dozens of news organizations covered this study. Below, I compare the coverage of five of them. I wouldn’t label it “The Good, The Bad, and The Ugly,” per se.

How about “The Very Good, The Not-So-Bad, and The Pretty-Darn-Ugly”

The very good

The New York Times was one of the outlets that set a very high standard by making the following key points quite clear:

  • What makes the study novel is it is the first large-scale, prospective study (1.8 million women over about a decade) to address the breast cancer risk in newer hormonal contraceptives (which have lower hormone levels than older contraceptives).
  • It clearly established  that the absolute risk for breast cancer with the newer contraceptives “was small but measurable” (for every 100,000 women, hormonal contraceptive use accounts for about 13 additional cases of breast cancer a year).
  • Different delivery systems — like intrauterine (ie. IUD’s)  or implanted hormone delivery systems — carried equivalent risk to pills (Note: not all IUD’s contain hormones)
  • A reminder that contraceptive hormones — although long known to increase breast cancer risk — are also associated with a decreased risk of ovarian, endometrial, and possibly colorectal cancers.
  • The study had limitations: it didn’t take into account other factors that can affect breast cancer risk: breast feeding, drinking alcohol, and exercise.
  • It included an important caveat: breast cancer risk increases with age, and how long a woman is on hormonal therapy.

And New York Times reporter Roni Caryn Rabin was the only reporter I came across who noted that the study was funded by Novo Nordisk, the company that makes Vagifem, a topical estrogen marketed for menopausal symptoms. She also pointed out that two of the study authors, including the lead author, “have been employed by Novo Nordisk since the manuscript was accepted for publication.”

NBC touched on most of the above points covered by the Times. They appropriately emphasized the “small risk” high up in the story and provided this important context as well:

“It’s a disappointment to doctors who had hoped that lower doses of hormones in both oral and non-pill contraceptives might be safer than older birth control pills. But they stress there is no need for most women to abandon birth control pills for fear of breast cancer.”

The not-so-bad

The Guardian also included many of the most important points. They also highlighted some other aspects of the Danish study that many women on birth control would be curious about. Most notably, how the length of time on hormones affects risk: “among women taking the pill for five years, the study suggests, there would be an extra one case for every 1,500 women.” But this increased risk gradually disappeared over a few years after stopping the pill.

The Guardian also included this important quote from Kevin McConway, a statistician at the Open University in England who specializes in risk communication in the media:

“Like most other studies on hormonal contraceptives and breast cancer risk, this one is observational, so it cannot proved conclusively that the hormonal contraception is definitely the cause of the increased risk.”

Although Bloomberg covered some important ground in their reporting, they probably warrant a demotion to “The Bad” based on two things. First, the headline:

“Those Newer Birth Control Pills Don’t Lower Cancer Risk”

Notice they didn’t write ‘breast cancer’? A potentially massive oversight for those who don’t go past the headline and rush off to tell their friends: “birth control pills cause cancer!”

Speaking of massive, check out their opening line:

“Hopes that different formulations would remove a longstanding danger to women are dashed by a new study. Newer birth control drugs developed to replace those tied to cancer risk were thought to improve safety for the women who took them. It turns out they didn’t, according to a massive new study”

It’s a misleading one-two punch without context. The headline’s misleading generic reference to cancer is followed by unwarranted “dashed hopes” in the body text. Only further down in the article do we learn the relative risk of “about one extra case of breast cancer among every 7,690 women taking the drugs.”

But the damage has already been done.

The pretty-darn-ugly

Newsweek wasted no time with this fear-mongering headline: “Breast Cancer: Birth Control May Increase Risk By Up to 38 Percent”

This is the relative risk after 10 years on hormonal contraception. As with the Bloomberg framing, it’s only toward the end of the article that we’re provided with the much less startling absolute numbers.

The ending hits readers with a bizarre twist. Rather than point out that hormones may play a protective role in ovarian, endometrial, and possibly colorectal cancer …Newsweek finishes with this:

“… birth control may actually be protective against cancer on the whole, despite this increased risk for one type”

I can’t imagine what a roller-coaster ride that is for readers to go from that threatening headline to such a hopeful (albeit, very misleading) closer.

We see this reporting roulette frequently.  The quality of information that readers end up with is a spin of the wheel. The spectrum — as in this case — can be alarmingly wide. In cases in which the topic is esoteric the impact of this on consumers could be argued to be negligible. But in the case of oral contraceptives we’re talking about roughly 10 million woman in the United States alone. The impact of misinformation on this scale can become a public health issue.

I was encouraged that most of the reporting on this study was solid. The odds were fairly good that interested readers would walk away empowered with relevant information.

For those with an unlucky spin, I find myself left with a nagging concern: do they realize their bad luck?

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Comments (4)

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Rob Oliver

December 8, 2017 at 11:17 am

Not sure that trying to minimize this study’s findings is the right response. In point of fact, this is a very concerning observation that should affect birth control counseling in patients with a personal or family history of breast cancer

Michael Joyce

December 8, 2017 at 12:43 pm

Dr. Oliver,

Thank you for your comments. I have scoured what I wrote and don’t see anything that I feel could have been interpreted as “minimizing this study’s findings.” We focused on news stories about the study, not the quality of the evidence itself. Could you clarify what you meant?

Sue Rochman

December 11, 2017 at 12:34 pm

The NYTimes story did a good job of explaining risks/benefits. Unfortunately, the editors of the Wednesday, December 6th, NYT Evening Briefing (an email newsletter) didn’t do nearly as good a job.

Their summary of the story began: “Alarming news from the medical world …”

Tim Kirn

December 13, 2017 at 1:32 pm

Dear Michael,
I’ve got to agree with you that Ms. Rabin did an excellent job with the story in the New York Times. It seems she actually sat down and read the entire study, not just the abstract, because most of the numbers describing the actual risk, and giving perspective, were not her own enterprise. They were in the study and the editorial. I am not sure the writers of the other pieces read anything more than the abstract.
She also got comments from two different perspective, which is really informative.
Good reporting, it seems, is not trickery. It is simply good, conscientious effort to eschew the temptation to cut corners.
But I also believe you went overboard a little bit.
You mention that Ms Rabin noted that the research was funded and that two of the researchers are now employed by Novo Nordisk. You find it praiseworthy. I say: Meh?
Sure, reporters should look for bias in the information they are given. They should be suspicious. But the information here seems irrelevant and therefore uninteresting, so it is a waste of space.
One must acknowledge that there is an intense and inherent conflict of interest in any and all research at the start. A researcher starts with an idea. They are invested in that idea, intellectually, at least. That’s a bias. Then they expend a bunch of time into their work. Nobody wants to invest months or years in a project and not find anything noteworthy.
I would bet that this oral contraception and breast cancer risk report would not have been published by the NEJM if the researchers had found no elevated risk. That is what everyone expected; it would not have been newsworthy.
Every researcher wants to produce or, they know, their funding will dry up and, with it, their career. That is an incredible conflict of interest that in many ways exceeds that exerted by commercial funding.
Moreover, this research pointed out a liability associated with female hormonal treatment. Novo Nordisk makes Vagifem and other products used for hormone replacement therapy. (I am not sure if they all are still available here in the US.)
So, it would appear that the company exerted no influence on these researchers, since they said negative things about the products Novo Nordisk makes. That means the information is pretty irrelevant. Did she find any influence? Or have any reason to believe their might have been? It doesn’t seem so.
In addition, you kind of unfairly label the Newsweek story as “ugly.” You say that it is only towards the end of the story that this article provides the real accurate numbers, and that the beginning is misleading and attempts to scare readers.
Sure, the first paragraph probably should not have used the most dramatic number.
But, in point of fact, the second paragraph says “These results sound scary at first…..However, in practice, the picture is far more complex.”
Reads rather fair and accurate to me.
I believe that one difference we need to keep in mind regarding the two stories is that the New York Times story is almost twice as long! The Times does not have the space constraints that a Newsweek story does. Moreover, when one writes for a weekly newsmagazine one has to write a second-day lede and a second-day story, and that creates a whole bunch of limitations and constraints in what and how one writes. Many great reporters have found it very difficult to write for a newsmagazine because of the specific demands that imposes. Many very good newspaper writers have failed.
I do not know if the situation is appreciably different now that both publications primarily exist on the screen, but I must assume it is not.
Anyway, it seems unfair to compare the two as if they are exactly the same thing.