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Summary of breast cancer treatment outcomes in African-American women misses major limitations of the study

Breast cancer prognosis of African-American patients may improve with chemotherapy before surgery

Our Review Summary

This news release from Georgia State University describes some findings from a 10-year data review of African- and European-American women with breast cancer. Surprisingly, the data indicated for the first time that African-American women may benefit more from receiving what’s known as neoadjuvant chemotherapy, which means receiving chemo before surgery, which is not the typical order of treatments given to patients. It then explains this may lead to new treatment options that are more effective for African-American women, who have higher recurrence and lower survival rates compared to white women.

The news release left out some big details. The fact that recurrence of breast cancers in all patients was very low — 225 recurrences total (49 of which were African-American) out of 10,504 patient records studied — deserved some discussion in the release. Because of the relatively few women who received treatment in this way, the statistical significance was diminished. The news release should have better elucidated that, explaining these findings are essentially preliminary and more research is needed to see if this bears out in a clinical trial where more factors can be controlled.

 

Why This Matters

Unfortunately, a stubborn racial disparity in breast cancer survival persists, meaning women of color are far more likely to experience cancer recurrence–and in the case of metastasized cancers, shorter lifespans–than their white counterparts. Solutions are needed–and when they’re found, they’re certainly newsworthy. But because research is a slow process and takes years, if not decades, to confirm, news releases should be cautious in tone, and not overstate any potential positive findings.

Criteria

Does the news release adequately discuss the costs of the intervention?

Not Applicable

The news release did not discuss costs, but presumably receiving chemo before surgery–instead of after–does not considerably increase costs.

Does the news release adequately quantify the benefits of the treatment/test/product/procedure?

Not Satisfactory

The news release did not provide sufficient detail on the benefits of using chemotherapy before surgery in African-American women. All we’re told is that the data “exhibited trends” that indicated chemo before surgery led to less invasive recurrence. More numbers are needed to back that up.

The news release also did not provide useful information about characteristics of the patients who were helped by neoadjuvant chemotherapy.  Were there any common characteristics such as age, tumor size, body mass index (BMI), length of neoadjuvant treatment, or other characteristics that might help those newly diagnosed with breast cancer decide to pursue neoadjuvant treatment?  It’s widely known that breast cancer is not one uniform disease and that treatment — both neoadjuvant and adjuvant — varies.

Does the news release adequately explain/quantify the harms of the intervention?

Not Satisfactory

The news release did not discuss any harms of providing cancer treatment in this order–chemo first, surgery second.  We’re not aware that neoadjuvant chemotherapy is more harmful than standard treatment but it’s a valid question and the release would have been more helpful had it clearly stated that one way or the other.

Does the news release seem to grasp the quality of the evidence?

Not Satisfactory

The news release overstated the findings and made the research sound like it was a prospective clinical trial, with language like this: “We found that African-American breast cancer patients responded better to neoadjuvant chemotherapy than European-American patients.” That’s misleading.

The more accurate way to summarize the research might be: We found an association between neoadjuvant chemotherapy in African-American women and a lower rate of recurrence compared to European Americans receiving the same treatment.

Also, the release left out an important limitation to this finding, which was explained in the published study: “due to a low number of recorded patients that received neoadjuvant chemotherapy, statistical significance was diminished.”

The release should definitely have included the low numbers of recurrences among all study participants. Consider there were 10,504 patients in the study. Of those, clinical records indicated there were 49 recurrences among African American women and 166 recurrences among European-American women for a total of 225 recurrences. In addition, the release should have stated that no information on recurrence or non-recurrence was found for 4,273 of the 10,504 patient records examined for the study.

Readers with breast cancer and those who know breast cancer survivors and know those who have died from breast cancer deserve to know the very small number of patients these conclusions are based on. Should readers make treatment decisions based on the results for 49/10,504 patients?

Does the news release commit disease-mongering?

Satisfactory

The news release did not disease monger; breast cancer is indeed more deadly among African American women.

Does the news release identify funding sources & disclose conflicts of interest?

Satisfactory

The release clearly states the funder: “The study was funded by the National Cancer Institute of the National Institutes of Health.”

As far as conflicts of interest, one of the authors, Padmashree C. G. Rida, disclosed receiving a salary from Novazoi Theranostics, which is described in one business directory as a “Diagnostic Substances business / industry within the Chemicals and Allied Products sector.” It doesn’t appear that the tie represents a potential conflict relative to this study, but we think it’s always prudent to disclose such commercial affiliations in news releases.

Does the news release compare the new approach with existing alternatives?

Satisfactory

The news release discusses the alternative here (surgery first and chemo or other treatments after), and why they so far don’t seem to be as helpful to African American women.

Does the news release establish the availability of the treatment/test/product/procedure?

Satisfactory

None of the treatments given are new or experimental and it’s clear they’re readily available within cancer treatment facilities.

Does the news release establish the true novelty of the approach?

Satisfactory

The news release claims novelty with this statement: “This is the first clinical study to suggest that neoadjuvant chemotherapy (treatment prior to surgery) may improve breast cancer recurrence rates and patterns in African-Americans.”

To the best of our knowledge and based on an online search of related studies this is factual.

Does the news release include unjustifiable, sensational language, including in the quotes of researchers?

Satisfactory

There was no sensational or unjustifiable language, though the news release could have done a better job of stressing this was a data analysis conducted via combing through medical records — and not a clinical trial.

Total Score: 6 of 9 Satisfactory

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