Two quotes in the story also demanded a challenge from another perspective. One saying the study "suggests more high-risk women should consider taking raloxifene." And one saying "If women were not so risk-averse, we might actually be able to reduce the risk of breast cancer in high-risk women." In point of fact, some women who are fully informed will still be risk averse and may choose not to take either drug. That’s a point that didn’t come through in the story.
This is just an option for women who are concerned about their risk, but it is not something they must do. This is a genuine shared decision-making issue – an issue of tradeoffs and choices that the AP story emphasized but this one didn’t.
There is no discussion of the cost of these drugs.
The story states that tamoxifen reduces the risk of breast cancer by 50% and Evista reduces it by 38%; however, we’re not given absolute data to determine what that really means – and the absolute numbers are really small. According to the trial, 247 women in the tamoxifen group developed invasive breast cancer versus 310 in the Evista group.
The story provides data indicating that tamoxifen “doubles the risk of endometrial cancer” from 1 in 1,000 to 2 in 1,000 and Evista “doesn’t substantially increase the risk of endometrial cancer.” It would have been useful to provide the data for Evista as well, 1.23 in 1,000. Furthermore, there was no mention of the rate of blood clots or cataracts for these drugs.
Satisfactory in that the story indicates that this was a large trial (20,000 postmenopausal women) with a follow-up time of 7 years. However, it could have noted that for a prevention study, 7 years is not that long (there were very few cases of breast cancer in either group).
This story does not engage in disease-mongering.
The story interviewed one expert not directly involved in the research. However there was no mention that one of the main authors of the study received funding from Eli Lilly, the maker of Evista.
The story discussed the benefits and harms of tamoxifen and Evista; however, it could have mentioned how they compare to the other drugs used for prevention (i.e. toremifene and tibolone).
This story makes it clear that tamoxifen and raloxifene (Evista) are widely available, but are not widely used as breast cancer preventives.
The story makes it clear that tamoxifen and Evista have been approved for preventing breast cancer in high risk women, but concerns about side effects prevent many of these women from taking them.
The story does not appear to be based largely on a news 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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