This story reports on a large, randomized trial comparing conventional radiation therapy for breast cancer administered over several weeks to a one-time dose given at the time of breast conserving surgery. The study found that both treatments resulted in similar rates of breast cancer recurrence. The story does a nice job of describing the study and adding the appropriate caveats. For example, the writer makes it clear that the single-dose regimen may require subsequent conventional radiation therapy, as pathology results are not always available at the time of surgery. This story would have been vastly improved had it included data from the trial, mentioned costs, given more detail on associated harms, pointed out potential conflicts of interest, and adequately compared the single-dose radiation therapy to other accelerated radiation therapy regimens.
The inconvenience of conventional radiation therapy delivered over several weeks can be a real barrier for many women, particularly women who continue to work through treatment or those who are older and find it difficult to make every session. The story could have been easily oversold, but the writer maintained an appropriately cautious tone.
There was no discussion of costs, nor of the cost ramifications of the results.
The story indicated that the local breast cancer recurrence rate was the same for those who received conventional, external radiation and those who received intraoperative radiation; however, no data were provided.
While it was good that they noted that “[i]t’s best for women with a small tumor that is well-defined and involves only one portion of the breast,” it would have been much more meaningful had they defined “small” and included more details on the criteria for selection, as not all breast cancer patients meet the eligibility criteria for this treatment.
The story pointed out the potential disadvantages of this treatment, including that many patients (14%) who receive targeted intraoperative radiation therapy still require conventional radiation.
While the rate of major toxicities were, indeed, similar between those who received targeted intraoperative therapy and those who received conventional radiation, it would have been helpful to note that significantly more people in the intraoperative therapy group had wound seromas needing more than three aspirations. The story may have also noted that the conventional therapy was associated with a higher toxicity grade compared to the one-time therapy.
This story did a nice job of describing some important details of the study: the number of patients, their diagnosis, randomization, and the length of follow-up.
The story did not engage in disease mongering.
The story provided quotes from independent sources, but it failed to mention that the study authors received funding and consulting fees from Carl Zeiss, the manufacturer of the equipment used in this study. We think such disclosure should be part of any story – and it only requires a few more words.
While the focus of the study was to compare conventional radiation therapy to one-time intraoperative radiation, more than just a cursory mention of other accelerated regimens would have been useful. For example, MammoSite is administered for 5 days and is also delivered from inside the breast. Additionally, studies have demonstrated that a traditional external radiation administered over 3 weeks is as effective as the 7-week regimen for some patients.
The story makes it clear that this is a new treatment approach and has not yet been established as an available option.
While accelerated regimens of radiation therapy are gaining traction, the story makes it clear that delivering one dose of radiation during surgery is a novel treatment approach.
This 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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