This story reports on a potentially important development in the prevention of breast cancer among high risk, postmenopausal women.
The story is clear that this is an existing drug for osteoporosis that has not been approved by the FDA for use in breast cancer prevention. The story also does not make claims about when it may be approved for that purpose. There is no obvious disease mongering; the story accurately represents the prevalence and seriousness of breast cancer
Although there is mention of a clinical trial, the story does not describe the study design. Also not mentioned was the fact that the results have not yet been published or peer reviewed, so interpretation of the clinical significance of these results are difficult at this time. Benefits of treatment are quantified in relative terms only. The viewer is told that raloxifene and tamoxifen both reduce the incidence of breast cancer by about 50%, however there is no context provided for these numbers. Most viewers would want to know “50% of what?” They want the absolute risk reduction. Viewers should have been told that even though the women in the study were high risk, the incidence of breast cancer over 5 years was still very low. The story also does not mention that raloxifene does not reduce the incidence of ductal carcinoma in situ (DCIS, which tamoxifen does), so it is not clear that when the story says the benefits are equivalent between the two drugs, if it will hold true if they include all breast cancer events (including DCIS, which is found quite commonly these days).
The story also omits an important fact: the decrease in incidence of uterine cancer and clots in the raloxifene group was not statistically different from the tamoxifen group. Although uterine cancer and blood clots are mentioned as harms of treatment, there is no mention of how often they occur. Other harms such as cataracts and stroke are not mentioned.
No costs are mentioned. According to the website for the STAR trial, the cost of Raloxifene is about $75 per month, while Tamoxifen costs about $100 per month. Because these drugs have to be taken for long periods of time, cost is an important issue.
No costs are mentioned. According to the website for the STAR trial, the cost of raloxifene is about $75 per month, while tamoxifen costs about $100 per month. Because these drugs have to be taken for long periods of time, cost is an issue.
Benefits are quantified in relative terms only. The reader is told that raloxifene and tamoxifen both reduce the incidence of breast cancer by 50%, however there is no context provided for these numbers. Viewers would want to know 50% of what? They would want to know the absolute risk reduction. Viewers should have been told that even though the women in the study were high risk, the incidence of breast cancer over 5 years was still very low. The story also does not mention that raloxifene does not reduce the incidence of ductal carcinoma in situ (DCIS, which tamoxifen does), so it is not clear that when the story says the benefits are equivalent between the two drugs, if it will hold true if they include all breast cancer events (including DCIS, which is being found much more commonly now).The story also omits an important fact: the decrease in incidence of uterine cancer and clots associated with raloxifene was not statistically significant.
Although uterine cancer and blood clots are mentioned as harms of treatment, there is no mention of how often they occur. Other harms such as cataracts and stroke are not mentioned.
Although there is mention of a clinical trial, the story does not describe the study design. Also not mentioned was the fact that this study has not yet been published or peer reviewed.
No obvious disease mongering. The story accurately represents the prevalence and seriousness of breast cancer.
Only one source, a physician at the National Cancer Institute, is quoted. In a story of this potential magnitude, other sources and perspectives are needed. It doesn’t add that much time to a story, even in broadcast.
Tamoxifen is mentioned as the alternative to raloxifene.
The story is clear that this is an existing drug for osteoporosis that has not been approved by the FDA for use in breast cancer prevention. The story does not make claims about when it may be approved for that purpose.
The story is clear that raloxifene is an existing drug that is currently used to treat osteoporosis.
We can’t be sure if the story relied solely or largely 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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