This story reports on several newer, noninvasive prenatal screening tests called cell-free DNA tests. These tests work by examining pieces of fetal DNA from a blood sample taken from the mother. Although more accurate than traditional screening tests (blood tests plus an ultrasound), the new tests are not accurate enough to provide a definitive diagnosis. This can only be obtained from a more invasive procedure such as amniocentesis. The story did a good job of explaining the confusion surrounding these new tests, which is a result of some doctors and women not understanding the tests’ limitations and accuracy levels compared with other tests. The story could have provided more numbers — including costs and false positive rates — to help readers better understand the tradeoffs involved.
The new prenatal screening tests discussed in this story are not diagnostic tests, and patients may not understand the difference between the certainty of a diagnostic test and the uncertainties of a screening test. Solid health reporting can help women understand these crucial distinctions and make better decisions. The stakes are high when women are making choices about whether to terminate or keep a pregnancy based on these results.
The story mentioned that insurance coverage of the new tests varies, but no indication of an actual dollar amount was given.
The accuracy level of the new screening tests was described as better than existing screening tests (blood tests plus ultrasound), but this benefit was not quantified (i.e., the screening tests can detect X disease Y% of the time compared with traditional tests, or false alarms occur for X% of new tests vs Y% for traditional screening tests). A linked study abstract provided this detail, but the jargon-filled text would be difficult for most readers to understand. A quick rundown of those numbers would have been easy to provide in the story itself.
The story cited several harms associated with the new screening tests, including the risk that some women may terminate a pregnancy based on the screening results alone without follow up diagnostic tests. It also noted that the tests can pick up minor genetic abnormalities that might previously have gone unnoticed.
The study cited in the article (through a hyperlink) reports that the new screening tests did a better job of detecting chromosomal abnormalities. An independent expert quoted in the story agrees that the new tests are more accurate than traditional screening tests. The story’s bottom-line take on the evidence seems appropriate.
The story sought out several expert sources for their opinions about the testing, and it appropriately noted that one of these sources (Dr. Lee Shulman) is a consultant to firms selling the new screening tests. However, it failed to note that another of these expert sources (Dr. Diana Bianchi) was also a paid consultant to a testing company. In addition, it didn’t caution readers that the study the story links to was paid for by a testing company.
The story did compare and contrast the new prenatal screening tests to traditional diagnostic tests like amniocentesis and chorionic villus sampling, which are more invasive.
The story mentioned the tests were new to the market (available since 2011), and that many doctors were still not familiar with them. The story made it clear that these tests were not regulated by the FDA.
The story discussed how this type of prenatal testing differs from traditional testing and emphasized that the tests were so new that their usefulness and limitations were not clearly understood.
The story does not appear to rely on a news release. The reporter clearly spoke to several expert sources.
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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