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Read Original Story

Study links MRI breast cancer detection to rise in mastectomies

Rating

2 Star

Study links MRI breast cancer detection to rise in mastectomies

Our Review Summary

The story focuses on a preliminary report of an upward trend of mastectomy at one institution, possibly related to greater use of  pre-operative MRI screening.  However, it is not clear other than mastectomy rates falling then rising that there has really been much of a finding here. The story mentions that pre-operative screening with MRI is relatively new; however, the story does not mention if pre-operative MRI is standard practice at most breast cancer treatment centers. 

The story suggests several hypotheses for the upward trend in mastectomy, even among women not screened with MRI.  On this point, the story does not mention the cost of pre-operative screening via MRI, or if changes to healthcare reimbursement policies have affected the decision to have a mastectomy v. lumpectomy w. radiation.  Federal law requires that health insurance cover the cost of breast reconstruction following mastectomy. 

The story mentions lumpectomy as another treatment option for breast cancer, but radiation is not discussed.  (Without radiation, recurrence is higher with lumpectomy than mastectomy; with radiation, the treatments are considered equal.) The focus of the report is that MRI may detect more diffuse cancer, or early-stage cancer in the contralateral breast (the breast not being treated), which may limit options for surgical treatment. More than one site of low-grade Stage 0 cancer would not necessarily preclude lumpectomy and radiation.  For Stage 0 cancer, or Ductal Carminoma in Situ, lumpectomy in several parts of the breast may not be cosmetically acceptable, but this is a subjective assessment that requires input from a patient and not only provider opinion (in a sense the cosmetic result only is "better" after mastectomy if a woman has reconstruction); Someone may prefer a smaller or moderately misshapen breast compared to flat chest wall.

Lastly, there is little independent reporting and the story seems to rely heavily on an ASCO press release, although information is not taken verbatim. But there are lots of caveats to this data (or lack thereof) to figure out what it means, if anything. and there is some effort at putting the results of this early clinical data in context. 

Criteria

Does the story adequately discuss the costs of the intervention?

Not Satisfactory

The story does not mention the cost of pre-operative screening via MRI, or if changes to healthcare reimbursement policy have affected the decision to have a mastectomy v. lumpectomy w. radiation.  On this point, federal law requires that health insurance cover the cost of breast reconstruction following mastectomy.  Time and energy away from work and family may also influence the decision to have a mastectomy v. lumpectomy w. radiation. Radiation can take several weeks following surgery. 

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

Not Satisfactory

The story reports on an upward trend for mastectomy with greater use of MRI screening.  This is a claim that has not been well substantiated — namely whether MRI lowers recurrence by better targeting those who need mastectomy. The story does not mention this. 

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

Not Satisfactory

The story does not mention any potential harms.

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

Not Satisfactory

The story describes the basic study design and suggests several hypotheses for the upward trend in mastectomy, even among women not screened with MRI. However, it is not clear other than mastectomy rates falling then rising that there has really been much of a finding here. The story does mention that this study is a preliminary report from a single institution, but does not mention that that results have not been published in a peer-reviewed journal. 

Does the story commit disease-mongering?

Satisfactory

The story does not engage in disease mongering. However, the story does not mention that not all DCIS (or stage 0 cancer) needs to be treated and that even if there were several sites of low-grade cancer, a woman might still be a candidate for lumpectomy and radiation.

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

Not Satisfactory

The story seems to rely heavily on information taken from an ASCO news release. One of the study invesitgators is cited, but there is no other independent reporting.

Does the story compare the new approach with existing alternatives?

Not Satisfactory

The story mentions lumpectomy as another treatment option for breast cancer, but  radiation is not mentioned.  The focus of the report is that MRI may detect more diffuse cancer, or early-stage cancer in a contralateral breast (the other breast not being treated), which may limit options for surgical treatment; however, several sites of low-grade Stage 0 cancer would not necessarily preclude lumpectomy and radiation.   For Stage 0 cancer, or Ductal Carminoma in Situ, lumpectomy in several parts of the breast may not be cosmetically acceptable, but this is a subjective assessment that requires input from patient not only provider opinion (in a sense the cosmetic result only is "better" after mastectomy if a woman has reconstruction) someone may prefer a smaller or moderately misshapen breast compared to flat chest wall.

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

Not Satisfactory

The story does not mention if pre-operative MRI is standard practice at most breast cancer treatment centers.  The story focuses on a preliminary report that MRI screening prior to breast cancer surgery may increase detection and influence a woman’s surgical choice, with more women choosing mastectomy.  

 


Does the story establish the true novelty of the approach?

Satisfactory

The story mentioned that pre-operative screening with MRI is relatively new. 

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

Satisfactory

The story seems to rely heavily on an ASCO press release, but information is not taken verbatim, and there is some effort at putting the results of this early clinical data in context, but there are lots of caveats to this data (or lack thereof) to figure out what it means, if anything.  E.g. "It is not clear that the experience at the [Mayo] clinic reflects that of the entire nation." 

Total Score: 3 of 10 Satisfactory

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