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Mammograms May Not Be Fool-Proof at Catching Second Cancers

Rating

4 Star

Mammograms May Not Be Fool-Proof at Catching Second Cancers

Our Review Summary

Although the story addressed most of our criteria satisfactorily, it didn’t:

  • include information about the psychological and financial costs of biopsies for women with a false positive
  • mention the possible confounding factors such as the biological factors associated with treatment of the first cancers that were noted by the study authors.

 

 

Why This Matters

Women already diagnosed with breast cancer are at risk of developing a second breast cancer.  Breast cancer survivors would benefit from evidence of the accuracy of screening mammography in detecting second breast cancers.  In addition, this evidence is useful in determining clinical practice guidelines.

Because there are nearly two million breast cancer survivors, accuracy of screening affects many women.  While over 40,000 women die each year of breast cancer, the majority of those diagnosed survive their disease.

Criteria

Does the story adequately discuss the costs of the intervention?

Not Satisfactory

The article does not include information about the psychological and financial costs of biopsies for women with a false positive diagnosis of breast cancer.  Among women with a personal history of breast cancer, 1.7 % were referred for biopsies that determined there was no second breast cancer while 1% of the women without breast cancer had false positive determinations.

The article does point out that 18% of women with a personal history of breast cancer were called back for additional imaging or biopsies compared with 8.3% of those without breast cancer but there is no discussion of the psychological or financial costs connected with the additional imaging.

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

Satisfactory

By quantifying the benefits of screening mammography for women with a personal history of breast cancer in absolute numbers, the story presents this information accurately and in a useful, understandable way for women with breast cancer.

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

Satisfactory

The story discusses false positives & interval cancers & provides explanations of both of these problems associated with screening mammography.

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

Not Satisfactory

The story does not explain that the study was a retrospective study based on mammograms performed from 1996-2007 in five states at facilities affiliated with the Breast Cancer Surveillance Consortium.

There is no mention in the story of the possible confounding factors such as the biological factors associated with treatment of the first cancers that were noted by the study authors.

The story also fails to include information about the subgroups of women with the highest observed cancer rates for whom the study authors note that alternate screening might be considered.

Does the story commit disease-mongering?

Not Satisfactory

The headline of this story misleads the reader by stating that “Mammograms May Not Be Fool-Proof at Catching Second Cancers.”  No type of screening for breast cancer is fool-proof whether it is for an initial diagnosis or for a second breast cancer.  Regarding the accuracy of screening mammography for an initial breast cancer diagnosis, the Komen for the Cure website states that in women age 50 and older “…between six and 27 percent of breast cancers may be missed by mammography alone.”  Mammography is most effective in women 50 and older.

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

Satisfactory

Quotes from two independent sources are included in the article.  Dr. William Audeh, director of the Wasserman Breast Cancer Risk Reduction Program at Cedars-Sinai Medical Center, presents possible explanations for some of the higher false positives among women with a personal history of breast cancer.  Quotes from both Dr. Audeh and Dr. Robert Smith, director of cancer screening for the American Cancer Society, point out that screening mammography may not have been as effective among women with a personal history of breast cancer as it was in those without a breast cancer diagnosis but that most of the cancers detected were stage I or ductal carcinoma in situ, a non-invasive breast cancer.
The article could have noted that study authors declared no conflicts of interest and  that the study was funded by a grant from the National Cancer Institute.

Does the story compare the new approach with existing alternatives?

Satisfactory

Satisfactory mostly because of the inclusion of the comments by Dr Audeh about MRI, which is really the only acceptable alternative to mammography for followup of breast cancer survivors, and it is still unclear how MRI and mammography should be used in concert.

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

Not Applicable

Not applicable.  Mammography is widely available and recommendations for annual mammography screening after a breast cancer diagnosis are standard. So the story didn’t need to specifically discuss the availability.

Does the story establish the true novelty of the approach?

Satisfactory

Satisfactory. The novelty of mammography is not in question, and the whole point of the story was the new study about mammography’s performance in breast cancer survivors vs. controls.

It may have been helpful for readers to know that the study was the first to examine the accuracy of screening mammography for women with a personal history of breast cancer.

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

Satisfactory

The article does not rely solely on a news release.  It includes several explanatory quotes from Dr. Diana Miglioretti, one of the co-authors of the study as well as quotes from two doctors not connected with the study.

Total Score: 6 of 9 Satisfactory

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