Our Review Summary
The American Society of Clinical Oncologists (ASCO) has released updated guidelines on adjuvant endocrine therapy in breast cancer. The story met many of our criteria, but missed the mark by insinuating that all postmenopausal women with hormone receptor-postiive breast cancer should use aromatase inhibitors: "The committee preparing the guidelines recommended, therefore, that all postmenopausal women with this type of breast cancer use aromatase inhibitors either before or after tamoxifen."
This statement from the guideline suggests something different: "The Update Committee supports careful consideration of adverse effect profiles and patient preferences in deciding whether and when to incorporate AI therapy."
Rather than framing this as a universal recommendation, the story could have emphasized the nuances that shared decision-making on these issues must take into account. Some discussion of decision-making came late in the piece, but too little, too late.
Why This Matters
The women for whom this drug is recommended are older and have fairly low risk of dying of breast cancer. Aromatase inhibitors have not been shown to increase overall survival compared to tamoxifen; therefore, women have the opportunity to make an informed decision based on the risk and benefits of these drugs. The story failed to emphasize this point.
The story specifically points out that generic tamoxifen costs $21.90 a month and the aromatase inhibitor, Arimidex®, costs $379.80 a month. The story was also quick to note that a generic form of Arimidex® is now available and costs much less. Going one step further, the story included a discussion of how the cost of treatment can factor into the decision-making process.
This piece did not provide any data, which is a significant oversight in a story like this. While aromatase inhibitors do appear to lower the risk of recurrence compared to tamoxifen, the difference is not that large in absolute terms. Readers wouldn’t know how big or small is the potential benefit.
The story discussed the potential side effects associated with both tamoxifen and aromatase inhibitors; however, no numbers were given to give a sense of the scope of the potential harms. The harms associated with these drugs is an important issue, as the number of women who stop using tamoxifen and aromatase inhibitors due to side effects is very high. Many women – something like 40% after three years – discontinue taking these drugs because of problems they encounter.
While the story mentions that the guidelines are based on a systematic review of recent studies, it doesn’t provide the reader with much about the quality of those studies. It would have useful to note how many studies were included in the systematic review, the number of patients included, and how long they were followed. Also, because of the variety of questions that have been or could be raised about guideline-setting these days, it would help to give more detail about who’s behind these besides just "A leading group of cancer experts" or an "ASCO committee which prepared the guidelines."
This story did not engage in disease-mongering.
The story interviews experts not affiliated with the study; however, it failed to point out that some of the authors had received funding from pharmaceutical companies.
This story provides an overview of how aromatase inhibitors compare with tamoxifen in terms of risks and benefits, and also mentions that all three aromatase inhibitors were equal in their benefit.
The availability of tamoxifen and aromatase inhibitors for preventing recurrence in breast cancer patients is not in question. The story briefly hints at availability when it states: "Tamoxifen has been a mainstay of treatment for decades, while aromatase inhibitors are a more recent entry into the field. Both drugs are used as "adjuvant" therapy, meaning they are used after surgery and chemotherapy and/or radiation to prevent the cancer from coming back."
It’s clear from the story that tamoxifen is not new and that aromatase inhibitors “are a more recent entry into the field.” The story also states that aromatase inhibitors have been a standard part of care before the guidelines were released.
The story does not appear to be based on a press release.
Total Score: 6 of 10 Satisfactory