This news release sets out to describe a novel technical enhancement to magnetic resonance imaging (MRI) technology using a fibronectin-targeting contrast agent that has the potential to detect micrometastases (breakaway tumor cells that can spread) and to help predict how aggressive the spreading cancer is likely to be. The release deserves good marks for packing in a great deal of information about how cancer spreads and how this technology might potentially play a role in facilitating earlier detection. Nevertheless, we had some significant concerns with how the findings are presented to readers. Most troubling is that the release fails to note that the work was done in mice until about two-thirds of the way through. It’s simply misleading not to acknowledge that the research involved mice somewhere high up in the release rather than burying it far down in the document.
Another nugget missing from the early paragraphs is that it’s the “enhancement” (i.e. a new contrasting agent) rather than “MRI” itself that is of interest and novelty here. That could confuse readers who at first glance may be led to believe that standard MRI can now help physicians find these early new seeds of cancer, as well as predict their level of severity and presage their conquest.
Surprisingly, there is also no mention of the scientists’ claims that the work was the first demonstration of the effectiveness of this form of molecular MRI/contrast agent technology in the detection of breast cancer micrometastases. And there is little or no real quantification related to the sensitivity and specificity of the detection method, particularly as compared to current gold standard imaging or use of other biomarkers to detect breast cancer spread.
So despite some notable strengths, this release’s omissions and lack of attention to the most important findings and details make it overall a confusing and potentially misleading account of the research.
Metastases have been recognized as the major cause of death in breast cancer patients for at least half a century, and scientists have expended vast resources in an effort to: a) detect them early enough to begin new or systemic treatments; and b) figure out which tumor types are most likely to spread; and c) find and exploit biomarkers likely to give the earliest possible clue to spread. Thus, the results of new research such as the work from the National Institutes of Health and Case Western Reserve described in this release have the potential to alter the landscape of breast cancer diagnosis and therapy, and eventually improve outcomes for breast cancer patients. The biology of metastases is complex, however, and readers need information that is carefully put in context and in a realistic time frame with respect to clinical application.
The release would have benefited from information about the potential costs of enhanced MRI, and about the overall current costs of current methods of breast cancer screening, diagnosis and therapy. The release certainly gives the impression that this technology could soon be deployed in humans, so some discussion of cost would be warranted.
The release didn’t include information about how much better the enhanced MRI technology was shown to be (compared to MRI alone and cryo-imaging combinations) in detecting metastases. The release does note that the investigators “verified” that the new MRI method could detect micro metastases less than 0.5 mm, but offered no comparative measures of what other detection methods have to offer.
The release seems overly optimistic here. It says testing by the researchers “showed that the agent is readily cleared from the body and has a low level of retention in tissues. Therefore, they expect it will be safe if ultimately developed for clinical use.” We think it would be best to conduct the necessary studies before commenting optimistically on the potential safety of the agent — after all, the point of conducting the studies is that we don’t know yet if the agent is safe or not. And even if it does turn out to be safe, there could be potential side effects that patients should know about. Also, the experiments involved mice, and it’s not clear if this technique would require a patient to submit to a whole body MRI in order to find metastases.
The release takes far too long to notify readers that the study involved mice. Imaging mice injected with cancer cells is not the same as imaging human women with breast cancer. This is unfortunate, since it negates what is otherwise a relatively strong description of the several ways the researchers demonstrated the value of enhanced MRI imaging for metastases.
No mongering with respect to breast cancer itself.
The article noted that the research was partially funded through an NIH grant. There are no conflicts of interest.
As noted earlier, the release had some information about alternatives, but it was somewhat disjointed and the reader would have a hard time understanding that there are indeed alternatives to this approach without reading the original paper.
Although it takes time to get there, the release does explain that this is not available for clinical use now and will not be until further work is done.
The release never makes clear what the “news” is — that indeed this, according to the researchers, is the first demonstration in animals of a technique that appears to detect micrometastases safely and perhaps better than “gold standard” imaging now in use.
We’ll give the story the benefit of the doubt here. The headline and lede paragraphs don’t make clear that this is not about standard MRI, or that the work was done in mice. However, we’ve already docked points for those infractions, and we think the language was otherwise responsible.
Systematic, Criteria-Driven
The tale of two “negative” studies. Or, how spin is applied to make research findings look more impressive. A must read. https://johnmandrola.substack.com/p/the-tale-of-two-negative-studies
The @nytimes chose to interview one of the editors of the @AnnalsofIM (publisher of this paper) who "gushed with extraordinary glee: It’s huge! There are very few things that reduce your mortality by 30%."
Turns out coffee is not one of those few things despite all that glee. https://twitter.com/garyschwitzer/status/1533202075928215558
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