This is a classic case where one newspaper's (the Washington Post) original story on a topic was not done justice in a shortened version picked up by another news organization (the St. Louis Post-Dispatch). The article describes new American Cancer Society breast cancer screening guidelines that now recommend that certain women at high risk of developing breast cancer receive annual MRI in addition to mammograpy and self exam.
The original Washington Post story ran 975 words; the St. Louis story ran 491 words. Many of the criticisms noted above were adequately addressed in the original Washington Post piece.
Missing in the St. Louis version but covered in the Washington Post original story:
We have written before on this site about how unfortunate it is that some readers in some markets don't get to see the original version of a story as it is syndicated and re-distributed and repackaged in other places. This is another example of the important information that a reporter put in the original story – information that was left out in a shortened version – all for the sake of saving 484 words.
The shortened St. Louis version of the original Washington Post story mentions only the cost of a single MRI. It didn't discuss whether insurance would cover these tests and it didn't discuss the cost-effectiveness of such a strategy for breast cancer screening.
The original Washington Post story touched on all of these points: "While MRIs are expensive — $800 to $2,000 — the studies indicate that the exams are cost-effective for this high-risk group, the panel found. No one has estimated what the overall cost to the nation would be if the recommendations were fully implemented, or how many insurance companies would pay for the exams."
In the shortened St. Louis version of the original Washington Post story, there is only one line that says "MRIs plus mammography can double the number of cancers found." But what are the absolute data?
But the original Post story stated: "For those women, MRIs plus mammography can double the number of cancers found, the panel said, detecting them in 6 percent of high-risk women screened, compared with about 3 percent for mammograms alone."
The St. Louis version comes up short on this criterion.
The story stated "MRI tends to produce false-positives at about twice the rate of mammography, forcing more women to undergo repeated tests and sometimes biopsies unnecessarily and subjecting them to anxiety, distress and discomfort. But the panel concluded the benefits outweigh the downside for high-risk women."
In the shortened St. Louis version of the original Washington Post story, there is no evidence presented for the recommendation that MRI should be used for breast cancer screening in selected women. Readers have no way to know the strength of the evidence for such a recommendation. Is this based on expert opinion? Randomized controlled trials? It's not stated.
But that St. Louis version left out material that was in the original Post story: "After reviewing research on MRI since 2002, a panel of experts assembled by the American Cancer Society endorsed annual MRI screening for women whose risk is about 20 percent above average for any of several reasons, including testing positive for one of the known breast cancer genes; having a close relative — mother, sister or daughter — who has tested positive for one of the genes; having at least two close relatives who have had breast cancer; or having had chest radiation for Hodgkin's disease."
The shortened St. Louis version of the original Washington Post story seems to have a screening bias. It only used a comment from an American Cancer Society spokesman – hardly an independent voice since the story was about new ACS guidelines. No other possibly dissenting voices were heard.
But the original Post piece stated: "While many patient advocates and breast cancer experts welcomed the guidelines, others questioned whether there is enough evidence to justify the recommendation. Echoing the debate over mammography, they noted that detecting cancer early does not necessarily translate into saving lives and can subject women to unnecessary tissue biopsies and other treatment and anxiety."
We find the St. Louis version lacking in this criterion.
The shortened St. Louis version of an original Washington Post article quotes only one source of information and he works for the American Cancer Society, so he is not an independent source.
But the original post piece had this perspective: "You can find a lot of cancer, but that's not the same thing as helping people live longer or better," said Russell Harris of the University of North Carolina. "It's unclear how many women really will be helped and how many will be hurt by over-diagnosis and overtreatment."
The St. Louis version lacked this balancing perspective.
The article mentions briefly the alternative of mammography screening, but what's lacking is a discussion of not screening at all. Of course, the new guidelines apply to a higher-than-average risk group of women for whom screening may make more sense. But, it's reasonable to include a discussion of "no-screening" when talking about any screening program.
The shortened St. Louis version of the original Washington Post story lacked this perspective. The Post touched on it with the quote: "You can find a lot of cancer, but that's not the same thing as helping people live longer or better," said Russell Harris of the University of North Carolina. "It's unclear how many women really will be helped and how many will be hurt by over-diagnosis and overtreatment."
The story doesn't explicitly state that MRI is currently "available," but most people probably understand that this technology is around, or at least have heard of it for use with other applications.
The story states that MRI for breast cancer screening would be a new tool physicians can use, making it clear that this is a new approach for breast cancer screening (although not a new technology, per se).
This criterion is not applicable in this case. The story in question is a shortened St. Louis version of an original Washington Post story. We are confident that the Post story did not rely solely or largely on a news release. It is unfortunate that the St. Louis paper didn't rely more heavily on ALL of the content in the original Post piece.