Breast Cancer Study Offers New Hope

Does the story adequately discuss the costs of the intervention?

Not Satisfactory

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.

Does the story adequately quantify the benefits of the treatment/test/product/procedure?

Not Satisfactory

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.

Does the story adequately explain/quantify the harms of the intervention?

Not Satisfactory

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.

Does the story seem to grasp the quality of the evidence?

Not Satisfactory

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 states that many women were able to have "successful" lumpectomies instead of mastectomies after presurgical treatment with aromatase inhibitors. But we receive no information about what the definition of "success" is here. While it’s important that these women were able to receive a less invasive surgical procedure, the real "success" will depend on whether there is excess recurrence of cancer at the same site. We won’t know this until patients are followed for several years.    
• The study is expected to be — but hasn’t yet been — presented at a conference in a few weeks and so hasn’t been subjected to peer review or even the collegial questioning of conference attendees. This kind of scrutiny often leads researchers to revise downward their estimates of benefit or play up caveats that previously weren’t mentioned or emphasized.

Does the story use independent sources and identify conflicts of interest?

Not Satisfactory

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.

Does the story compare the new approach with existing alternatives?

Not Satisfactory

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.

Does the story establish the availability of the treatment/test/product/procedure?

Not Satisfactory

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.   

Does the story appear to rely solely or largely on a news release?

Not Satisfactory

The story is based exclusively on a press release.