This is a story that highlights a possible new means for predicting the future course of a breast lesion, ductal carcinoma in situ or DCIS. Although many women may think (or even be told) that a diagnosis of DCIS is a diagnosis of breast cancer, the story accurately defines it as a precancerous lesion.
The story deserve praise for highlighting the variable course following a diagnosis of DCIS and the reporting on the resulting under- and over-treatment this causes.
Best parts:
Weakest point:
Overall, though, a solid job of reporting on this important women’s health issue.
There was no estimate for the costs for the type of analysis detailed in the story, however that is understandable with a test that is this early in development.
One author said that every patient whose biopsy had two key biomarkers "developed a subsequent tumor in the next 10 years and 70 percent of the later tumors were invasive breast cancer."
The story never mentions the false negative rate (the number of women predicted to have no recurrence who actually recurred). If overtreatment is the standard approach, the new test adds value only if its accuracy is sufficient to identify women with a very low probability of recurrence who can safely forego treatment. With no mention of the false negative rate, the reader cannot judge the utility of the test in determining when treatment can be avoided. It failed to report that even among the small number of women studied, there was one predicted to have a tumor that would not reoccur, who actually did develop a recurrence. So while this panel may improve prognostic ability, it is not guaranteed.
The story explained that the data came from a pilot study published inn the journal Cancer Cell. It discussed other as-yet-unpublished results and explained they weren’t published. It was clear that the story was based on a presentation at a scientific meeting, and even said it was a "hastily scheduled session." Near the end of the article, researchers state that "more, bigger studies are under way to confirm and refine the predictive value of the molecular signatures." That makes it pretty clear that more than just the 200 cases in validation set are necessary to establish predictive value, though the tone is not sufficiently objective. It would be preferable to state that these preliminary results must be tested, not that future tests will "confirm and refine" the initial findings.
The story did not distort the picture of ductal carcinoma in situ (DCIS).
One researcher who was not involved in the research was quoted.
Although the story did not provide a list of the characterstics of DCIS lesions that are currently catalogued in order to provide some assessment of their future course, implicit was the understanding that we are currently unable to adequately predict this.
The story explained that "more, bigger studies are under way to confirm and refine the predictive value" of the experimental approach, so it is quite clear that this approach is still being developed.
It was clear from this story that the analysis described could become a new clinical tool for predicting the course of DCIS.
Does not appear to rely on a press release.
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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