But our reviewers were troubled by the story’s headline and lead sentence, which they felt overreached with its suggestion that the study results “weaken the case for preventive mastectomy” in women who test negative for certain cancer mutations, because there there was never strong evidence that these women were at increased risk and that mastectomy was something that they would consider.
Overall, though, sound reporting on an important issue.
Inheriting a mutation in BRCA1 or BRCA2 can greatly increase a woman’s lifetime risk of breast cancer, but there is some uncertainty about whether close relatives of BRCA carriers also have a higher risk even if they test negative. These new data are reassuring because they suggest that women who test negative are not at increased risk and do not need to take special precautions such as more aggressive screening and surveillance. Current guidelines do not recommend increased surveillance or mastectomy for this population and this study confirmed that as a reasonable approach.
The story did not discuss the cost of the BRCA test, which according to the National Cancer Institute can range from several hundred to several thousand dollars.
The story accurately reports the study’s implications in the middle of the piece when it says: “The results support current guidelines that say non-BRCA mutation carriers in families affected by the BRCA genes don’t need special screening beyond mammography as recommended for the general population…” And the study does go into detail and quantify how the test helps refine estimates of breast and ovarian cancer risk.
However, the headline and opening sentence bothered our reviewers. The story suggests that women who are relatives of BRCA carriers, but who tested negative for the mutation themselves, no longer need to consider preventive mastectomies to reduce their risk of developing breast cancer. In fact, preventive mastectomy would be considered an extreme intervention in women who test negative for the BRCA mutation, so these findings may have little bearing on such decisions. The findings also have no bearing on the decision of women who are BRCA-positive to undergo preventive mastectomy. Accordingly, the results are neither “reassuring” nor “weaken the case” for preventive mastectomy in women who might be considering this intervention.
The story was concerned primarily with the implications of a negative BRCA test result, so we won’t fault it for not going into detail on the many potential harms of a positive or ambiguous test result. The story did stipulate that BRCA-negative women may still have an elevated risk of cancer if they have a family history of the condition, which is an important caveat.
The story provides the necessary details about the research and explains one of the reasons why the current population-based study is considered more reliable than previous clinic-based studies which found increased risk in first-degree relatives of non-BRCA carriers.
There was no overt disease-mongering. However, the story could have made it more clear that BRCA-associated tumors account for only a small percentage — 5% to 10% — of all breast cancers.
Two outside sources were consulted, and there didn’t appear to be any unidentified conflicts of interest.
There aren’t really any alternatives to BRCA testing for women with a strong family history of breast cancer, so we’ll rate this not applicable.
However, in just another line or two, the story could have noted that there are other, less common genetic mutations that also confer an increased risk of breast cancer. And it could have mentioned that there are other options available to help estimate a woman’s risk of breast cancer (e.g. the Gail model, Claus model, etc). These are not genetically based but some do account for family history to help refine risk estimates.
It’s clear from the story that BRCA testing is available to women who want it.
The story does not overstate the novelty of the BRCA test or the current research findings.
The study includes interviews with experts who were not involved with the current research, so we can be sure the story wasn’t based on a press release.