This article reports findings from a paper published in the Journal of Clinical Oncology that demonstrate a recent rise in double mastectomies among women diagnosed with cancer in one breast. It generally does a good job of explaining that the benefits of the treatment are unknown. It explores the question of what may motivate women to make this decision.
The anecdote is well chosen because the woman is a nurse and therefore more credible as someone making an informed choice. It also allows us to hear one woman explain how she made what she knows to be a decision based more on emotion than fact.
The article would have been stronger had it taken a closer look at the risks and benefits of the whole range of breast cancer treatments, and what risks a woman diagnosed with breast cancer faces of the cancer spreading, returning or killing her.
While cost is very unlikely to drive a decision about breast cancer treatment, it’s increasingly important for the media to educate readers about the true underlying costs of medical treatments. In this case, the reporter cites "higher costs" as one disadvantage of double mastectomy. This obligates the reporter to specify those costs.
To know how the cost of either a single or double mastectomy compares to the costs of lumpectomy plus radiation would have added additional value.
Generally the article does a good job of using data to show how the number of double mastectomies has increased over six recent years.
But there is one serious flaw: The report states that, "Women removing a single cancerous breast have a 1 percent chance per year of suffering cancer in the other breast." That sounds fearsome, and like a reasonable motivation to undergo double mastectomy. But we have no idea how that 1 percent compares to a woman of a similar age who has not been diagnosed, to a woman with high risk who has not been diagnosed, etc.
In addition, the reporter is rounding up from a recurrence rate of between .5 percent to .75 percent, as stated in the research article. The average reader may estimate a 40 year old woman with 40 more years life expectancy has risk of recurrence in other breast of 40 percent; but data suggest it is closer to 20 to 30 percent.
The article is also unclear about the evidence regarding mortality: Have no studies looked into the question of whether a double mastectomy increases lifespan, or are there studies that show no difference?
The report mentions slightly higher risks of surgical complications and infections. It would have been useful to specify how serious and frequent these outcomes are, but this is not a serious flaw.
The article fairly reports that the study was based on an analysis of several years of data gathered for a large government study and reported in a credible medical journal.
The report makes clear early on the limitation that this study could not explain reasons for women making the choice.
The reporter does nothing to exaggerate the risks of cancer spreading from one breast to the other. In fact, the reporter does a good job making clear that the risk is lower than many patients think.
The reporter interviews the lead author of the study, two additional credible medical experts and one patient. The patient, a nurse, is a more credible source than one often finds in news stories.
The article sufficiently compares bilateral and single mastectomy, and reports that the lumpectomy with radiation option is more common.
The article implies, accurately, that double mastectomy is available at any facility that provides breast cancer treatment.
The article makes clear that this is the first large federal study of the issue. As for the procedure itself, no claims are made for its novelty.
There is no evidence that the report relies on the journal’s press release.
Systematic, Criteria-Driven
Monday at #ADA2021, an infectious disease epidemiologist, a journalist, and a researcher shared perspectives on communication of risk in the era of COVID-19: http://ow.ly/ROfR30rMeE7 @AstleyCM @garyschwitzer @berthahidalgo @ADA_DiabetesPro
Shoutouts to @susan_bewley @drkevinknopf @MichaelBaum11 in this call for more than fawning coverage from press releases for these kinds of stories.
Also, linked history inside goes back 5 years just on Grail apparently trying to become Holy Grail. https://twitter.com/garyschwitzer/status/1408849696416841731
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