The story has the same basic content and quotes as this press release put out by the Siteman Cancer Center at Washington University four days before the HealthDay piece. As you might expect from a lightly edited press release, the HealthDay story has very few of the elements we deem critical to quality health journalism. No information about costs, no evaluation of the evidence, poor discussion of benefits and harms, and no independent perspective. A disappointing effort to say the least.
HealthDay stories get picked up by major news outlets and are read by many. These readers think that they’re getting independent journalism–not a rehash of a press release.
No discussion of costs in this story. It could have pointed out that two of the estrogen-lowering drugs tested in this study are off patent and relatively cheap, whereas the third drug, exemestane, is a brand name drug that remains quite costly.
Again, the story talks about "successful" surgery and "good" outcomes without ever defining what is meant by these terms. Did these women live longer? Have fewer recurrences? Have better quality of life than if they hadn’t had the treatment? This is hugely important information for anyone who might be considering this treatment.
There is no discussion of any potential harms from aromatase inhibitors. These drugs can cause joint pain and sexual problems which lead many women to discontinue using them. There also is concern that these estrogen-lowering drugs may decrease bone density and increase the risk of osteoporotic fractures. This is an outcome that can have severe health consequences for older women.
The story included no cautionary statements about limitations of this study or how it should be interpreted. We can think of a couple:
The story did not resort to disease-mongering.
The only perspective we receive in this story is that of the investigators with the study, who provide a uniformly positive take on the results. No independent views are provided.
Chemotherapy also is sometimes used presurgically to shrink tumors and allow for less invasive surgery instead of mastectomy. The story should at least have pointed this out and could have attempted to provide some comparison of the two approaches.
The story should have done a better job of explaining how the drugs discussed in this story, known as aromatase inhibitors, are currently used in cancer treatment and why this study may represent an advance over current approaches. All of the drugs discussed are currently approved by the FDA for breast cancer, but they are typically administered to women only after surgery or as an adjunct to other drugs in order to prevent a cancer recurrence. The new study is testing these treatments prior to surgery to see if this improves outcomes. The story isn’t explicit about most of this and assumes that readers are already aware of this background. Many probably are, but others are not.
The story doesn’t provide any history about the use of aromatase inhibitors for presurgical cancer treatment, but neither does it inappropriately attempt to portray the treatment as novel.
The story is based exclusively on a press release.