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Surgery prevents breast cancers in high-risk women

Rating

1 Star

Surgery prevents breast cancers in high-risk women

Our Review Summary

Somewhere in the news gathering and reporting arsenal of an international wire service, there needs to be a better effort on an important study than this. 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 could/should have been reported – a five-star story.

This story is not only the weakest of the ones we reviewed on a study of women with an elevated risk of cancer connected to mutations in their BRCA1 and BRCA2 genes and the effects of preventive surgery, it is riddled with factual errors and mischaracterizations that more likely to confuse than inform readers.

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

 

Why This Matters

It is essential that reporters covering health and medicine display basic competence in handling risk statistics and in describing study design and methods. This story failed on both those counts.

Criteria

Does the story adequately discuss the costs of the intervention?

Not Satisfactory

The story does not mention the costs of testing, surveillance or treatment.

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

Not Satisfactory

Most of the references to benefits are vague, such as, “you can save the majority of women who would have died of breast cancer.” The story also does not make clear that the reduction in the risk of death was due entirely to removal of ovaries and that the researchers did not report that preventive mastectomy reduced the risk of death among these women. In addition, the factual errors in the description of cancer risks facing these women (described above) makes it impossible for readers to get an accurate understanding of the potential benefits of preventive surgery.

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

Not Satisfactory

The story mention psychological issues facing women who undergo mastectomy and early menopause that results from ovary removal, but the brief reference to harms and lack of important details understates the trauma, side effects and complications that preventive surgery causes women.  There are also potential harms from the increased surveillance, for example, with ensuing biopsies.

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

Not Satisfactory

This story does not describe the study, its strengths or limitations, or how it compares to other research on this topic. It mistakenly states that 2,482 women in this study had preventive surgery, when actually that was the total number of women included in the analysis, most of whom did not have surgery.

Does the story commit disease-mongering?

Not Satisfactory

Because the story lead clearly notes that the study involved only women with BRCA1/2 genetic mutation and it also points out that 10 to 20 percent of breast and ovarian cancers are linked to BRCA1/2 mutations, it could be argued that the story meets this criterion. But then a potentially confusing reference to “women with a family history of cancer” may lead many readers to believe the findings may be relevant to that much larger population of women. Also, at the end of the story it calls breast cancer “the leading global cancer killer of women.” While technically accurate based on current statistics from the International Agency for Research on Cancer, the description obscures the fact that in developed nations (where genetic testing is available) the overwhelming majority of women who develop breast cancer are successfully treated.

Actually, this story dramatically understates the cancer risks facing women who carry BRCA1/2 mutation by confusing the lifetime risk of cancer with the relative risk compared to women who don’t have the mutation. For example, the story erroneously reports that women with the mutations have a “56 to 84 percent higher” risk of breast cancer… when in fact that is their lifetime risk… which is several times higher than the commonly used figure of a 12 percent lifetime risk of breast cancer for women in the general population.

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 and one other expert who was not involved in the 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

The story does not discuss the alternatives available to women.

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?

Not Satisfactory

The story leaves out any mention of earlier research on this topic and does not point out that some women have been opting for preventive surgery for many years.

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

Satisfactory

Although several of the quotes in this story are taken from the journal articles, the reporter also interviewed at least one expert.

Total Score: 2 of 10 Satisfactory

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