This story reports on results from a recently updated randomized trial, which found that tamoxifen and raloxifene (Evista) are both effective options for preventing breast cancer in high-risk, postmenopausal women; however, as the writer notes, there are trade-offs for each. In addition to meeting many of our criteria, the story nicely frames this as an opportunity for patients to make an informed decision based on the risks and benefits associated with each drug.
The story emphasized choice and weighing of tradeoffs – essential points in looking at this topic and this study.
The story specifically points out that generic tamoxifen costs 30 cents a day and Evista costs $3 a day.
The piece provides results in terms of both absolute and relative risk. According to the story, about 20,000 women were included in the trial and they "took one drug or the other" for 5 years. A total of 310 women taking Evista developed invasive cancer compared to 210 women taking tamoxifen. It would have been useful, however, if the writer clearly stated how many women were in each treatment group.
For each of the two drugs, the story quantifies the risk of uterine cancer in absolute terms. The story also indicates that, compared to tamoxifen, Evista was associated with fewer hysterectomies, blood clots and cataracts; however, data are not provided for these side effects.
According to a physician quoted in the story, between 27 and 30 million women are at high-risk for breast cancer and may qualify for these drugs. The study defines "high-risk" as those with gene mutations or a strong family history and stresses that only postmenopausal women were studied; however, what the trial defines as high risk (1.66% over 5 years) is high for a younger woman, but is considered average risk for a 60 year old woman.
The story interviews experts not affiliated with the study; however, it fails to mention that one of the authors received funding from Eli Lilly, the maker of Evista. Furthermore, the story closes with commentary from a patient who switched to Evista from tamoxifen due to concerns about tamoxifen’s higher rate of side effects. Providing perspective from a patient who choose tamoxifen over Evista would have rounded out the story nicely.
This story provides a nice comparison of the benefits and harms of tamoxifen with Evista; however, a mention of how these compare with the other drug option in the class, toremifene, would have been useful.
The availability of tamoxifen and raloxifene (Evista) is not in question; however, the story does point out that they are not widely used for preventing breast cancer in high-risk women who have never been diagnosed with the disease.
The story indicates that tamoxifen has been the “longtime gold standard” for treating cancer once it’s diagnosed and Evista is typically used for treating osteoporosis. While both have already shown to be useful in preventing breast cancer in high-risk women, safety concerns have prevented many women from using them for this purpose.
The story does not appear to be based on the press release.
Systematic, Criteria-Driven
Monday at #ADA2021, an infectious disease epidemiologist, a journalist, and a researcher shared perspectives on communication of risk in the era of COVID-19: http://ow.ly/ROfR30rMeE7 @AstleyCM @garyschwitzer @berthahidalgo @ADA_DiabetesPro
Shoutouts to @susan_bewley @drkevinknopf @MichaelBaum11 in this call for more than fawning coverage from press releases for these kinds of stories.
Also, linked history inside goes back 5 years just on Grail apparently trying to become Holy Grail. https://twitter.com/garyschwitzer/status/1408849696416841731
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