Don’t get us wrong: this study is a BIG deal. But this story didn’t serve a US audience well at all.
Costs not mentioned, even though that could be an important issue in colon cancer screening and even though the researchers made a case for potential cost benefits of their findings. Why would that be left out?
And who calls it a "flexi-scope" test? It’s flexible sigmoidoscopy – and to call it anything else may only confuse readers.
This important study offers the first high-quality evidence supporting the use of endoscopy in colon cancer screening. For the UK and other countries that don’t use currently endoscopy in screening, the benefits of implementing the study’s approach could be enormous. But in the US, endoscopy, including sigmoidoscopy and colonoscopy, is already part of the screening recommendations. This study didn’t compare the new sigmoidoscopy schedule to any approach used in America. Thus, there’s no evidence that once-only sigmoidoscopy will save any more lives than other colon cancer screening methods commonly used here.
This point may seem like a technicality, but for a US audience reading this headline and the opening sentence, without the context above, we think many readers will get the false impression that a new breakthrough will save 40% of the Americans who die each year because their colon cancers were not caught by the current screening net. And that’s not what the study said.
Costs of this once-only technique (combined with periodic fecal blood tests) are not discussed. The study authors themselves argue in the paper for the potential cost benefits of their approach. Why would the story leave this out?
The per-protocol benefits in the study are quantified, but — see above — we have to give the story a strike on this criterion for misrepresenting the key benefit of the study for US readers. The study did not show that "A five minute colon cancer test could reduce the number of deaths from the disease by 40 percent," at least not where US readers live.
Also, we would have liked to have seen the Number Needed to Treat data published in the study, as opposed to only the relative benefits.
Although the rates of complications were low, potential harms of the test, polyp removal, and once-only timing — including rates of false-positives and false-negatives — are not mentioned. The story does point out that further follow-up is necessary to assess how long the protective effect observed in the study lasts.
For the world at large, regardless of how they currently screen for cancer, the study offers the first high-quality evidence — a large randomized controlled trial — supporting the use of endoscopy in colon cancer screening. (The article mentions the large population in the study but not the important type of study.) The study is also valuable for validating the idea that removing polyps reduces rates of colon cancer.
But, for US readers, we feel the story misplaces the meaning of this evidence. They may read it as saying that this new evidence can suddenly save 40% of the Americans who die from colon cancer each year. An article disseminated widely in the US should have more clearly evaluated what the evidence does and does not mean for US lives.
It’s worth pointing out that the study didn’t follow subjects long enough to support the article’s statement that "Researchers said the test needed to be done just once in a person’s lifetime." Subjects were followed for about 10 years. The results, therefore, indirectly suggest that a sigmoidoscope every 10 years is as good as one every 5 years. That’s why, as quoted later in the article, Dr. Ransohoff calls for further follow-up.
Finally, the article paraphrases a US expert, Dr. Ransohoff, in his suggestion that the evidence may make people rethink how sigmoidoscopy fecal blood tests compares to colonoscopy. That may be true, even in the US. But we feel the story should’ve pointed out that the study itself didn’t compare these two approaches, or that we don’t have strong evidence supporting either one’s superiority. In fact, Dr. Ransohoff himself notes in his editorial that there are some indications that the benefits for the study’s approach may turn out to be less than those of colonoscopy or a periodic schedule (vs. once-only) sigmoidoscopy. Perhaps not, but we just can’t say. (The point.)
The story does not exaggerate the burden of colon cancer.
The story does interview an outside source, and we give it kudos for consulting the Lancet expert commentary by Dr. Ransohoff. Also,sources of funding are listed.
It would’ve been helpful to not only name KeyMed but explain that it’s a company that makes endoscopes. Also, the story claims that "Experts said the findings could make some authorities reconsider how they look for colon cancer." That’s a little sweeping. Especially considering that the only expert interviewed said the findings won’t make the ACS reconsider their guidelines.
The article mentions the current screening program in the UK and the ACS recommendations in the US. it’s also keen to point out that colonoscopies are preferred over sigmoidoscopies in the US despite any evidence from clinical trials. Yet it fails to acknowledge that this study doesn’t add any data comparing the two. In general, no comparative data — or the lack of such data — are mentioned, only a generally positive coloring of the approach in the brand new study, and an implication of superiority.
The story states that the test is available in the U.S. and is one of the screening techniques recommended by the ACS, albeit on a different schedule.
The article doesn’t claim that the test is novel. And it does establish that a once-only sigmoidoscope (combined with periodic fecal blood tests) would be novel. But we have to review this story on behalf of the US eyes who come across it, and American readers could believe there’s been a medical breakthrough that could save thousands of US lives. The true novelty for US readers is a bit drier and more subtle: A) it’s the first high-quality evidence supporting the current residence of endoscopy in screening recommendations, and B) there’s a new schedule and combination of screening tests that may be more cost-effective and convenient, although we don’t know yet if it would detect more cancers and save more lives than what we’re currently doing stateside.
We don’t see evidence that the story relied on a news 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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