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Read Original Story

Estrogen Lowers Breast Cancer and Heart Attack Risk in Some

Rating

4 Star

Estrogen Lowers Breast Cancer and Heart Attack Risk in Some

Our Review Summary

The New York Times provides vital context for this discussion of estrogen use after menopause. Kudos for the  parsing of risk and including skepticism about the value of these results from outside researchers.

 

Why This Matters

Millions of women have already taken hormone replacement, and more are poised in the delicate transition where such therapy may be considered. The medical confusion is tricky for them, and this story will be widely read. Giving a true picture of this confusion is vital to helping women maneuver among unknowns.

Criteria

Does the story adequately discuss the costs of the intervention?

Not Satisfactory

The story does not touch on costs.

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

Not Satisfactory

Mixed bag here. The story does some of this, giving readers a “quantifier” example about how many of 10,000 women might forgo heart attacks due to taking estrogen, based on the study’s findings. But sadly, they don’t give a similar quantifier for the perhaps exaggerated headline: “Estrogen lowers breast cancer risk.”  The same type of absolute risk calculation shows that the margin of benefit, if it exists, would be small: 8 fewer cases per 10,000 women per year. There may be a statistically significant difference, but it is small.  Because of this omission, we judge this one unsatisfactory.

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

Satisfactory

Kudos to the The Times for parsing risk carefully. Among these: estrogen alone carries different risks than estrogen-with-progestin,
estrogen-alone for older women is much riskier than for younger women and risks for women who still have a uterus (unlike those who have had a hysterectomy) are also different. Last, but still important, the form of estrogen used in the study is not typically used now, so conclusions about benefits cannot be assumed to follow to the current form (estradiol.)

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

Satisfactory

Good job by the Times at digging below the surface and explaining nuance to readers. The critics, who published an editorial in the same JAMA issue point out that the WHI finding of decreased breast cancer risk with estrogen runs counter to results of many other studies showing an increased risk.

Does the story commit disease-mongering?

Satisfactory

The story does a good job of discussing a variety of risks without exaggerating any of them. If anything, they may exaggerate the benefits in the headline.

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

Satisfactory

The story benefits from direct interviews with sources holding different perspectives.

Does the story compare the new approach with existing alternatives?

Satisfactory

The story delivered important information on how not all hormone replacement therapy is the same.  For example:

“A major caveat in interpreting the new estrogen data is that the study used conjugated equine estrogens, which are estrogen compounds derived from the urine of pregnant mares and marketed by Wyeth Pharmaceuticals under the brand Premarin. The brand has fallen out of favor with many women who are choosing treatments that contain estradiol, which is chemically similar to a woman’s natural estrogen. It is not known whether the benefits of estrogen shown in the Women’s Health Initiative would be replicated using a different type of estrogen.”

and

Dr. Chlebowski previously led research that showed cancer risks associated with combination hormone therapy, but he says the new data on estrogen alone show that in certain women, estrogen use to relieve menopausal symptoms is a “good choice.”

“When you look at the debate, people are saying hormones are good or not good — it’s been all or nothing. This calls attention to the fact that there are differences,” said Dr. Chlebowski. “I hope that separation will become clearer now.”

 

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

Not Applicable

Estrogen is widely available and story does not need to talk about that.

Does the story establish the true novelty of the approach?

Satisfactory

The story doesn’t make any inappropriate claims about estrogen, and it does appropriately try to frame the novelty of the research – “a finding that challenges the conventional wisdom about the risks of some hormones used in menopause.”

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

Satisfactory

The story includes independent reporting, so it’s clear it didn’t rely on a news release.

Total Score: 7 of 9 Satisfactory

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