The risk of developing breast cancer for a woman with BRCA1 or BRCA2 gene mutation increases dramatically. Recent advances in genetic testing can identify these women, but leaves them with very difficult decisions to make. Should they remove both breasts and/or the ovaries to drastically reduce the risk of breast cancer? This story gives a very human face to this quandry and presents some useful information. However, it has several flaws.
Although the story mentions double mastectomy and oophorectomy as treatment options, it does not mention other important alternatives, such as chemoprevention or active surveillance (watchful waiting). The story also does not address the important issue of timing of treatment. The increased risk is not for one year, but spread over a long period of time, so often women do not need to act immediately. Furthermore, the story does not adequately describe the nature of the available evidence for using the genetic test in combination with preventative surgery. Have there been controlled trials evaluating the benefit of this approach?
The story provides quantification of benefits in relative terms only. The story states that removing both breasts reduces the risk of breast cancer by 90% and that removing the ovaries also reduces the risk of ovarian cancer by 90%. From what % to what %? Readers need the absolute risk reduction figures. The story also states that women who test positive for BRCA1 or BRCA2 have up to an 87% change of developing breast cancer. However, according to the National Cancer Institute, this risk varies between 36% and 85%, a wide range not explictly stated in the story.
The story does mention some important potential harms of the testing, inlcuding the threat of lost insurance, the emotional impact, and the ethical questions it raises. The story quotes multiple independent sources.
The story does not mention costs of the test.
The story provides quantification of benefits in relative terms only. The story states that removing both breasts reduces the risk of breast cancer by 90% and that removing the ovaries also reduces the risk of ovarian cancer by 90%. But 90% of what? Readers need the absolute risk reduction figures. The story also states that for women who test positive for BRCA1 or BRCA2 have up to an 87% change of developing breast cancer. However, according to the National Cancer Institute, this risk varies between 36% and 85%, a wide range not explicitly addressed in the story. The story should have provided this baseline risk for ovarian cancer as well.
The story does mention some important potential harms of the testing, inlcuding the threat of lost insurance, the emotional impact, and the ethical questions it raises.
The story does not adequately describe the nature of the available evidence for using the genetic test in combination with preventative surgery. Have there been controlled trials evaluating the benefit of this approach?
By accurately describing the incidence and seriousness of breast cancer, the story avoids disease mongering. However, the story quotes the upper range of the risk of developing breast cancer in women who test positive for the gene mutations. The story states that women who test positive for BRCA1 or BRCA2 have up to an 87% change of developing breast cancer. However, according to the National Cancer Institute, this risk varies between 36% and 85%, a wide range not specifically addressed in the story.
The story quotes several sources.
Although the story mentions double mastectomy and oophorectomy as treatment options, it does not mention other important alternatives, such as tamoxifen or active surveillance (watchful waiting). And none of the patient interviews was with a woman who chose active surveillance. This throws the story out of balance. The story also does not address the important issue of timing of treatment. The increased risk is not for one year, but spread over a long period of time, so often women do not need to act immediately.
The article clearly states that the genetic test for BRCA1 and BRCA2 have been on the market for 10 years. It does not elaborate on how widely available the tests are.
The story clearly states that genetic testing is a new, but growing industry.
Because the story quotes multiple independent sources, the reader can assume that the story does not rely on a press release as the sole source of information.
Systematic, Criteria-Driven
Monday at #ADA2021, an infectious disease epidemiologist, a journalist, and a researcher shared perspectives on communication of risk in the era of COVID-19: http://ow.ly/ROfR30rMeE7 @AstleyCM @garyschwitzer @berthahidalgo @ADA_DiabetesPro
Shoutouts to @susan_bewley @drkevinknopf @MichaelBaum11 in this call for more than fawning coverage from press releases for these kinds of stories.
Also, linked history inside goes back 5 years just on Grail apparently trying to become Holy Grail. https://twitter.com/garyschwitzer/status/1408849696416841731
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