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Read Original Story

Finding cancer that mammograms can miss

Rating

3 Star

Finding cancer that mammograms can miss

Our Review Summary

The focus of this story was a review of a newly-published study demonstrating added benefit of ultrasound in addition to mammography for women at increased risk of cancer due to dense breast tissue.  The story appropriately mentions why traditional screening methods may miss an early-stage tumor in this population. It is not the usual standard to do any other screening (aside from mammogram) in women with dense breast tissue situations, except for very high-risk BRCA carriers who now get MRI as well. Ultrasound is already available, as implied in the story, and not a new method of treatment. 

The broadcast does not mention that physicians and ultrasonographers in the study were trained using standardized screening protocols.  In a real-world clinical setting, the availability of properly training physicians and technicians can vary, resulting in greater false-negatives or false-positives.  The editorial by Dr. Kulk accompanying the JAMA source article states, "It is questionable whether the diagnostic accuracy achieved in the study..would have been the same if nonradiologists had performed screening ultrasound." The story could have mentioned this.

In addition, the story didn’t discuss costs, didn’t explain why this study was "the most definitive so far," and didn’t explain benefits in absolute terms which are probably most helpful to most viewers. 

Importantly, the story mentions that screening may need to be tailored to a woman’s individual risk profile, as well as her preferred screening schedule based on an assessment of risks and benefits.

Criteria

Does the story adequately discuss the costs of the intervention?

Not Satisfactory

The broadcast mentioned that a breast ultrasound is less expensive than MRI, but it does not list the cost. Medicare reimbursement for breast ultrasound is $85, "which does not fully cover the costs of perfoming and interpreting the examination." [ref Berg].  This highlights the common cost problem of insurance payments not being sufficient to cover costs.  The same situation applies for mammography – hospitals lose money on every mammogram they do.  The source article contains information on issues related to increased resources anticipated with additional screening. Discussion could have easily been included.

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

Not Satisfactory

The story does quantify some of the benefits of treatment, namely, 49% of cancers were detected by mammogram alone, and 78% of cancers were detected by mammography plus ultrasound. The broadcast does not list important absolute data included in the study, namely, that the addition of ultrasound found about 4 additional cancers per 1000 women (7.6 per 1000 with mammography v. 11.8 per 1000 with ultrasound and mammography). We believe that absolute benefit data are far more helpful for viewers and should have been included.  


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

Satisfactory

The story mentioned the potential harms of treatment, which may be an increase in false-positives, unnecessary biopsy, and anxiety.  False positives may decrease with additional screening, such as an MRI, or when ultrasound is done annually.  The high rate of false positives with mammography plus ultrasound meant that only about 1 in 10 women with cancer suspected on combined screening turned out to have cancer when biopsy was done, whereas about 1 in 5 women with abnormal mammograms alone actually had cancer.

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

Not Satisfactory

The story does not adequately discuss the study design, which is important, as it is one of the few large-scale randomized controlled trials evaluating ultrasound as an additional screening method for women with dense breasts. The story simply says this study was "the most definitive so far."  Why?  Who says?  Women with breast cancer are very well-informed and understandably curious for context and in-depth analysis. This story could have done more on this count. 

 

 

Does the story commit disease-mongering?

Satisfactory

The story does not engage in disase mongering.  The focus of the broadcast a review of a peer-reviewed JAMA paper showing ultrasound in addition to  mammography may find more early-stage cancers in women with dense breast tissue.  The story appropriately mentions the population at higher-risk, and why traditional screening methods may miss early-stage cancer in these women.

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

Not Satisfactory

The only physician or expert interviewed in the story was someone who only commented on how ultrasound works – not on the findings of the study. So the merits of the study were taken at face value without any independent expert perspective. 


Does the story compare the new approach with existing alternatives?

Satisfactory

The story mentioned MRI as a supplemental screening method for women at very high risk of breast cancer or recurrence due to a variety of risk factors, including dense breast tissue.  The story also mentions breast biospy if there is a suspicion of cancer.  Importantly, the story mentioned that screening may need to be tailored to a woman’s individual risk profile, as well as her prefered screening schedule based on risks and benefits.

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

Not Satisfactory

Ultrasound machines are typically available in most medical centers. The broadcast does not mention that physicians and ultrasonographers in the study cited were trained using standardized screening protocols.  In a real-world clinical setting, the availability of properly trained physicians and technicians can vary, resulting in greater false-negative or false-positive test results.  The editorial accompanying the source article states, "It is questionable whether the diagnostic accuracy achieved in the study..would have been the same if nonradiologists had performed screening ultrasound."

Does the story establish the true novelty of the approach?

Satisfactory

It is not the usual standard to do any other screening (aside from mammogram) in women with dense breast tissue situations, except for super high-risk BRCA carriers who now get MRI as well. Ultrasound is already available, as implied in the story, and not a new method of treatment. The study provides good evidence of the value of ultrasound as an additional screening tool.

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

Satisfactory

The story has some independent reporting and information does not appear to be taken from a press release.

Total Score: 5 of 10 Satisfactory

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