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Backing off chemo for breast cancer

Rating

2 Star

Backing off chemo for breast cancer

Our Review Summary

The story discusses a genetic test, Oncotype Dx, that may help some women with early-stage breast cancer determine their risk of recurrence, and thus help with decisions about chemotherapy. More tailored (often less) chemotherapy is a newer idea for women who may not benefit as much from this aggressive treatment with many side effects. However, the story does not mention the cost of the test ($3,600). Oncotype Dx may be cost-prohibitive for many women whose health insurance does not cover the test.

 
The story does not mention that the "study" was actually a group of preliminary research reports presented at the recent San Antonio Breast Cancer Symposium (SABCS). A few of these reports discussed the positive predictive value of the test; they have not been peer-reviewed.  The story did not mention that this test is validated only for women with node-negative breast cancer whose tumors are estrogen receptor-positive.

A favorable score on a genetic test does not mean a woman at lower risk will not benefit at all from chemotherapy; she may, in fact, benefit some over the long term, but not as much as a woman with a higher chance of cancer recurring.  Also, a woman’s values and ability to live with a certain amount of risk, though small, is still part of the decision to have chemotherapy or forgo this treatment.  The story focuses on younger women deriving a greater by not having to undergo chemotherapy if a recurrence score is low. This is only partially true, as younger women tend to have more aggressive breast cancer.  Older women with other health problems may also benefit from no chemotherapy.


 

Criteria

Does the story adequately discuss the costs of the intervention?

Not Satisfactory

The story does not mention the cost of this genetic test, or the issue of insurance coverage. Oncotype testing typically costs $3,600 without insurance.  There may be a cost-savings to insurance companies if a woman avoids chemotherapy.

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

Not Satisfactory

There is no quantification of the sensitivity or specificity of the test.

A favorable score on a genetic test does not mean a woman at lower risk will not benefit at all from chemotherapy; she may, in fact, benefit some over the long term, but not as much as a woman with a higher chance of cancer recurring.     Also, a woman’s values and ability to live with a certain amount of risk, though small, is still part of the decision to have chemotherapy or forgo this treatment.

The story mentions that younger women may benefit the most by not having to undergo chemotherapy if their recurrence score is low. This is only partially true, as younger women tend to have more aggressive breast cancer.  Older women with other health problems may also benefit from no chemotherapy.

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

Not Satisfactory

The story does not mention potential harms of genetic testing. A favorable score does not mean an individual woman at lower risk will not benefit at all from chemotherapy; she may benefit some over the long term, but not as much as a woman with a higher chance of cancer recurring.  Also, a woman’s values and ability to live with a certain amount of risk, though small, is still part of the decision to have chemotherapy or no chemotherapy. Decisions for chemotherapy are not based solely on the results of Oncotype Dx.

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

Not Satisfactory

The story presented no quantitative evidence for the Oncotype Dx test, which was the main focus of the story.  The story does not mention that this "study" was actually a group of preliminary research reports presented at the recent San Antonio Breast Cancer Symposium (SABCS). A few of these reports discussed the positive predictive value of the test; they have not been peer-reviewed.  The story did not mention that this test is validated only for women with node-negative breast cancer whose tumors are estrogen receptor-positive.

Does the story commit disease-mongering?

Satisfactory

The story does not engage in disease mongering. The story promotes the idea that less treatment with chemotherapy may be appropriate.

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

Not Satisfactory

No source is cited. The story could use more balance, including a discussion of Oncotype Dx and similar genetic testing in clinical practice. Breast cancer specialists, researchers who presented Oncotype DX studies at the San Antonio Breast Cancer Symposium and breast cancer patients could provide perspective on this test as one aid in breast cancer treatment decision-making. 

Does the story compare the new approach with existing alternatives?

Satisfactory

The story notes surgical options and other predictive tests for hormonal and biological therapies. The story mentions that less breast cancer treatment in the form of chemotherapy may be an option for women who score favorably on an Oncotype Dx test, that is, a woman’s genetic profile give her a more favorable prognosis. Aggressive treatment with some serious risks and only small benefit may not be right for women and genetic tests may help patients and physicians decide who is an appropriate candidate for chemotherapy.

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

Not Satisfactory

The story does not mentions if the test is currently available for all women.  A bigger issue here is that the cost of the test ($3,600). Oncotype Dx may be cost-prohibitive for many women whose health insurance does not cover the cost of the test.

Also, the test is not for all women with early-stage breast cancer: It is validated for node-negative breast cancer, tumors that are estrogen receptor-positive, and when Oncotype DX is used within six months of diagnosis. The story does not mention that is it time-limited and must be conducted within 6 months of diagnosis.

Does the story establish the true novelty of the approach?

Satisfactory

The story mentions this new genetic test that may help some women with early-stage breast cancer determine their risk of recurrence, and thus help with decisions about chemotherapy.  Other risk calculators such as Adjuvant! may also help women determin the benefit of chemotherapy and hormone therapies. More tailored  chemotherapy is a newer idea for women who may not benefit as much from more aggressive treatment.  The story focuses on information further validating this test.

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

Not Applicable

We can’t be sure if the story relied on a news release; no source is cited.

Total Score: 3 of 9 Satisfactory

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