Mammography (left) and MR imaging (right). Credit: RSNA
This cautiously worded release suggests that preoperative magnetic resonance imaging (MRI) scans of breast cancer patients may reveal additional cancers, while noting that it is not known whether additional treatment aimed at these newly discovered cancers helps or hurts patients. However, the release leaves out some of the study limitations, and the rather technical language may obscure the narrow group of patients that these results may apply to.
The study behind this release may be useful to surgeons planning treatment for certain women with breast cancer. While the release does describe the relevant circumstances, as well as some of the uncertainties about the potential benefits or harms of additional treatment aimed at cancers discovered through preoperative MRI scans, we would have liked the writers of the release to anticipate that readers might believe the study results apply far more broadly than they do.
The release does not discuss the cost of breast MRI or the cost of altering treatment based on the results of the imaging. In addition, we’d note that MRI may not be covered depending on insurance, and given the way some of the plans are currently structured, the cost may be prohibitive.
The release notes that potential benefits are uncertain and that the researchers’ conclusions that additional cancers found through MRI imaging might justify altering treatment plans is based on a belief that tumors larger than 1 cm are clinically significant, not specific study evidence. But we believe that the release should have specifically noted (as the journal article did) that other studies have not found benefits to treating tumors discovered through preoperative MRI, and then explained the different way this study looked at the issue. We have no data to suggest that treatment of the additional cancers (which in the case of multicentric disease would require mastectomy) improves outcomes. We know that if we look harder for additional cancers, we will find them. What is unclear is which of the additional cancers need to be found.
A quote near the top of the release notes that some women may be overtreated. But the release provides no specifics about what that means. In the case of an MRI-detected additional cancer, it could mean an unnecessary mastectomy. We’ll give a borderline satisfactory rating here, although more detail would have been welcome.
The release notes that this study is based on a review of patient records. It also points out that the study did not look at the results of treating the cancers found through MRI imaging, only that some of them were large enough to be considered clinically relevant based on general practice. The release would have been better if it specifically noted (as the journal article did) that many of the cancers found on MRI were not biopsied, thus making it more difficult to judge the potential threat they posed.
We will give the release a satisfactory rating on this criterion because it does point out that the MRI images were obtained during preoperative planning for women already diagnosed with breast cancer. However, the release would have been much better if it specifically warned that the researchers were not looking at MRI breast scans of women in the general population and that this study is not relevant to discussions about whether or not to include MRI in screening women.
Also, the wording of the release, in particular the final quote, could create confusion about how often MRI scans revealed “a larger tumor burden.” The quote refers to “a quarter of patients,” but it appears to refer to a quarter of patients who had tumors found through MRI (18 of 73 women), not a quarter of all 2,021 patients in the study. Writers of releases should be careful about technically-accurate language that could confuse or even mislead readers.
The release does not say how the study was funded. The journal article says the researchers “disclosed no relevant relationships.” Still, we think it is important to clearly note funding and disclosures in all releases, even when there are no apparent conflicts of interest.
As noted above, the release does not mention other studies that have indicated that cancers found on preoperative MRI scans don’t affect at least short-term patient outcomes. It also does not discuss using ultrasound to check the breasts of patients prior to surgery for a breast tumor discovered through mammography.
The release notes that MRI is widely used for screening high-risk patients and for pre-surgical planning.
The release nods to the fact that previous research in this area has been done. And it establishes what’s new when it acknowledges that “there has been some debate about the clinical significance of multicentric cancers found with MRI.” These new results, in the researchers’ view, suggest that these cancers are in fact clinically significant.
The release is careful to say that preoperative MRI may reveal additional cancers that breast cancer patients and their physicians may want to take into account as they plan treatment.
Systematic, Criteria-Driven
Take all the issues enmeshed in any cancer screening story and amplify it with the liquid biopsy issue. @AP's @CarlaKJohnson. did a solid job here. https://apnews.com/article/science-business-health-hodgkin-lymphoma-oregon-ca899bb9c4c7f1859d4e9ce16a1cf78d
Come on, NY Times; you must do better than this. Important research doesn’t need hype and the “breaking news” BS doesn’t help readers or patients. https://www.healthnewsreview.org/2022/03/nyt-proclaims-breaking-news/
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