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Breast Removal Reduces Cancer Risk In Some Women

Rating

2 Star

Breast Removal Reduces Cancer Risk In Some Women

Our Review Summary

We acknowledge that this is a complex issue.  But this is a topic that demands that news organizations rise to the challenge.

This story emphasizes the potential benefits of preventive surgery for women who have a high risk of cancer related to BRCA1 and BRCA2 gene mutations. It doesn’t mention any of the harm even though the consequences of treatment led the majority of women in this study to opt not to have the surgery. The story contains factual errors and misstatements that undermine its credibility.  It was the second weakest of four we reviewed on this study.

This story was reviewed by two journalists and one expert in breast cancer decision support.

And lest anyone think that our standards are too high, impractical and unachievable, see our review of the competing AP story, which is a model for how this should have been reported – a five-star story.

 

Why This Matters

Even when new evidence changes typical clinical advice or practice, news stories must avoid taking on a cheerleading role.

Criteria

Does the story adequately discuss the costs of the intervention?

Not Satisfactory

This story hints at the financial implications when it notes that the woman featured did not want her last name used because she is worried about her health coverage, but it does not report the cost of testing (which ranges from several hundred to several thousand dollars and may not be covered by insurance) nor the cost of intensive surveillance or surgery.

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

Not Satisfactory

The findings of this study do provide new evidence of benefits of preventive surgery for women with BRCA1/2 gene mutations. However, the story does not provide a balanced or complete picture. It reports only relative risk reductions without also including the absolute numbers of women who did or did not develop cancer. Also, the story includes a quote from a researcher claiming mastectomy reduced the risk of death, but the study did not report that outcome. While none of the women who had a preventive mastectomy was diagnosed with breast cancer during the study – and the women who had their ovaries removed were less likely to die – the researchers did not report that mastectomy reduced the risk of death for these women.

Also, the only woman included in this story was someone who had preventive surgery and did not develop disease. The story obscures the fact that the overwhelming majority (93%) of women chose not to have surgery also did not develop cancer during the course of the study.

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

Not Satisfactory

This story does not mention any of the harms of treatment. Although it could be assumed that readers understand that mastectomy and ovary removal are traumatic, this story does not inform them about other substantial harms, such as premature menopause. Indeed, most of the women included in this study had decided not to have surgery, presumably because of concerns about the heavy consequences. While the results of this study may lead many women with BRCA1/2 mutations to reevaluate the balance of benefits and harms, the story should have offered at least some overview of the reasons the decision to undergo these preventative procedures is so difficult.

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

Not Satisfactory

Although this study appears to be the best yet to look at this question, the story includes only a brief description that fails to explain either the study’s strengths or limitations. What’s more, the story was wrong when it described the study as tracking “nearly 2,500 women with the BRCA mutations who had surgery to try to prevent breast and ovarian cancer.” While there were nearly 2,500 women included in the analysis, fewer than half of them had preventive surgery.

The story reports that one expert says “women with the BRCA mutation should be counseled about genetic testing, and strongly consider it.” That statement simply doesn’t make any sense. How could a woman know she has the BRCA mutation before she has been tested for it?

Does the story commit disease-mongering?

Not Satisfactory

While the story notes that this study looked at women with BRCA1 and BRCA2 gene mutations, it then went on to claim that “Women who have a family history of breast cancer” can reduce their chances of getting cancer if they have surgery. In fact, most women with a family history of breast cancer do not have the specific genetic mutations studied by these researchers. The story is likely to make readers believe the findings are relevant to a far larger number of women than is actually the case.

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

Satisfactory

The story includes comments from an author of an editorial in the journal who was not involved in this study. Although the story does not report financial or other information about the sources, the study was funded by a variety of grants from public agencies and foundations and neither the researchers nor the editorial writers reported any relevant financial disclosures.

Does the story compare the new approach with existing alternatives?

Not Satisfactory

Although the story mentions that women who have BRCA1/2 mutations may opt for intensive monitoring to catch disease early, it portrays that option as unreasonable.

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

Not Satisfactory

The story does not mention that the type and quality of genetic testing, genetic counseling, surgery and surveillance offered to women in this study may not be available to women in other settings.

Does the story establish the true novelty of the approach?

Satisfactory

The story points out that this latest study is building on earlier work.

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

Satisfactory

The reporter interviewed a researcher, an author of a journal editorial, and a study participant.

Total Score: 3 of 10 Satisfactory

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