NOTE TO READERS: When this project lost substantial funding at the end of 2018, I lost the ability to continue publishing criteria-driven news story reviews and PR news release reviews - once the bread-and-butter of the site going back to 2006. The 3,200 archived reviews, while still educational, are getting old and difficult for me to technically maintain on the back end of the website. So I am announcing that I plan to remove these reviews from the site by April 1, 2021. The blog and the toolkit - two of the most popular features on the site - will remain. If you wish to peruse the reviews before they disappear, please do so by the end of March 2021. After that date you may still be able to access them via the Internet Archive Wayback Machine - https://archive.org/web/.
Read Original Story

Study finds rise in choice of double mastectomies

Rating

4 Star

Study finds rise in choice of double mastectomies

Our Review Summary

This article reports findings from a paper published in the Journal of Clinical Oncology that demonstrate a rise in double mastectomies among women diagnosed with cancer in one breast.  This may be overtreatment for many women.  The story may have been more balanced by interviewing a patient who chose less treatment and her rationale for this choice.

The story cites breast cancer experts who note that there is little difference between the surgical treatments in terms of dying from breast cancer. Importantly, the story notes that having a mastectomy does not reduce a recurrence risk to zero, as some cancer cells may remain. The story notes that physicians should provide women with as much information about the survival benefit of all treatments, including less invasive options for reducing the risk of a recurrence. The story lists other non-surgical options for prevention and active surveillance for women at high risk of or having a recurrence, or developing a primary breast cancer.

An important oversight of the story is the lack of discussion of radiation, which is often given with lumpectomy. Lumpectomy alone is not comparable to mastectomy without radiation. The story might have benefited from listing data comparing lumpectomy and radiation with mastectomy. On this point, foregoing radiation due to another health condition and/or preferences to avoid side effects may play into a woman’s decision to undergo a mastectomy or bilateral mastectomy. The story also didn’t mentioned that some reconstruction procedures (e.g. tram flaps) can only be done once, so women considering those may have double and do both at once.

 

Criteria

Does the story adequately discuss the costs of the intervention?

Not Satisfactory

The story does not list the additional cost of surgical treatment and reconstruction for the prophylactic mastectomy. While the focus of the story was to report the increase in these procedures, the story could list the average cost and the time spent recovering from bilateral mastectomy and reconstruction.

 


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

Not Satisfactory

The focus of the story was the increase in bilateral mastectomies in women diagnosed with breast cancer in one breast.  The story notes that the survival difference between lumpectomy and mastectomy is about the same; however, the story does not mention that radiation is given with lumpectomy in order to reduce the risk of recurrence. Lumpectomy is not comparable to mastectomy without radiation. The story might have benefited from listing these data comparing lumpectomy and radiation with mastectomy. The story appropriately notes that having a mastectomy does not reduce a recurrence risk to zero as some cancer cells may remain.

Does the story adequately explain/quantify the harms of the intervention?

Satisfactory

The focus of the story discusses the recent increase in bilateral mastectomy after the diagnosis of cancer in one breast.  This may be overtreatment for some women.  The story notes that physicians should provide women with accurate information about the survival benefit of all treatments, including less invasive options for reducing the risk of a recurrence.

Does the story seem to grasp the quality of the evidence?

Satisfactory

The story discusses recent data showing an increase in preference for bilateral mastectomy in women diagnosed with early breast cancer in one breast. These are women who would likely be candidates for either lumpectomy, lumpectomy and radiation or mastectomy. The story appropriately notes that having a mastectomy does not reduce a recurrence risk to zero as some cancer cells may remain.

Does the story commit disease-mongering?

Satisfactory

The story does not engage in disease mongering. The story reports SEER data on the increase in bilateral mastectomy in women diagnosed with breast cancer in one breast.

Does the story use independent sources and identify conflicts of interest?

Satisfactory

The story cites Dr. Tuttle, the lead author of the study; a woman who decided to undergo a bilateral mastectomy, though she only had cancer in one breast; and Dr. Gralow, who questions the trend of prophylactic mastectomies in women who have the option to undergo lumpectomy and radiation, or lumpectomy alone (for DCIS). The story may have been more balanced by interviewing a patient who chose less treatment, along with her rationale.

Does the story compare the new approach with existing alternatives?

Not Satisfactory

The story notes surgical treatment options for women with early stage breast cancer. However, the story does not mention radiation with lumpectomy. Forgoing radiation due to preferences to avoid side effects  may play into a woman’s decision to undergo a mastectomy or bilateral mastectomy. The story cites breast cancer experts who note that there is little difference between these surgical treatments in terms of dying from breast cancer.  The story lists other non-surgical options for prevention for women at high risk of developing breast cancer, or having a recurrence. The story also didn’t mention that some reconstruction procedures (e.g. tram flaps) can only be done once, so women considering those may have double and do both at once.



Does the story establish the availability of the treatment/test/product/procedure?

Satisfactory

The story notes surgical treatments available for women who are diagnosed with breast cancer. The story also notes via Dr. Gralow’s comments  that women should be appropriatley informed about the absolute survival benefits of their treatment choices.

Does the story establish the true novelty of the approach?

Satisfactory

The increase in double mastectomy as prophylaxis after a cancer diagnosis is a new finding. The focus of the story discusses this data and attempts to explain this trend.

Does the story appear to rely solely or largely on a news release?

Satisfactory

The story does not appear to rely on a press release and there are additional sources cited who are not affiliated with the study.

Total Score: 7 of 10 Satisfactory

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.