This story describes a new breast imaging modality that relies on injecting a radioactive label into the bloodstream and using a gamma radiation detector to see if tissue in the breast lights up, presumably identifying cancer cells. It is described as less painful than mammograms and perhaps cheaper than MRI. The story mentions the lack of evidence for its use as a test but at the same time provides perhaps overly enthusiastic patient anecdotes. The story makes good use of possibly disinterested experts, but their cautious statements may be overmatched by happy consumers and radiologists who have invested in the technology. The important caveat, appearing but perhaps overwhelmed in the story, is that it is not yet known whether the test works as well as current technologies (mammograms, ultrasounds and MRI), nor whether it can improve health outcomes. Whether or not it is cheaper than another test is less relevant than whether the information generated has clinical value.
If this story had provided some hard data about how well or poorly this new test performs in relation to standard practice, we would have thought more highly of it. But kudos for putting this caveat so high in the story (4th sentence): "not enough studies have been done to show it saves lives and money" and for trying to inject some caveats throughout.
Costs for this test were included.
Does it not seem odd that there are different prices charged for a test depending on who is paying? It is instructive that this was reported in the story, though a little more information about this practice would have been useful.
The story did mention that it is not yet known whether this test is of benefit to women. So we’ll give the story the benefit of the doubt. That said – there was a lot of space given to anecdotes about how pleased patients were to have had the test. Patient satisfaction was enhanced because the test was less invasive than a biopsy and there was very quick turnaround to get back information on test results. While these are real benefits, the story should have explored the value of these things in the context of unknown utility for the test.
The harms of the test were not explicitly reported. Injection of a label that emits gamma irradiation may or may not be risky; the article is silent on this.
Most important is the issue of relying on a test for which the outcomes remain uNPRoven. Could this test miss a certain subset of cancers allowing them to progress? Might it identify lesions that aren’t cancers, causing undo concern and lead to unnecessary treatment? The story failed to detail the implications of relying on an uNPRoven technology or the harms that might result.
The story mentioned several times that the utility of this test has not yet determined. But the story persisted in presenting arguments favoring the use of this test. This was an important shortcoming of the piece.
So while the story did include a clear statement that ‘there’s not a shred of evidence’ that this technology will find more cancers, the story included a comment from a patient who stated she was ‘happy to know her cancer had not returned’. The unknowns described in the story would indicate that her trust is unfounded. The story should have pointed out the potential harm of relying on an uNPRoven technology.
Did not engage in overt disease mongering. The headline for the story was not consistent with the content, but that’s not the reporter’s fault.
The story included quotes from a clinician who has invested in the equipment needed to run this test for his practice as well as from a clinician with radiological imaging expertise. In addition, there were patient quotes attesting to consumer pleasure with the test.
It would have been very helpful to include critical assessment for how the test results could be validated.
The story mentioned breast biopsy and MRI imaging as other possible options available to women in need of follow-up assessment to their mammogram results. For completeness, the story should have included mention of ultrasound as a follow-up to assess a mass observed with a mammogram.
The story was clear that there is limited availability for this test.
The story reported appropriately about a potentially useful test for determining more quickly whether a finding on a mammogram is related to a breast cancer or not.
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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