This story summarizes an as-yet-unpublished research study that performed risk assessments for breast cancer among women age 40 to 44 visiting a specialty breast clinic. Of the 900 women whose risks were assessed, about 50 percent had an above-average risk for breast cancer, the analysis found. The study did not examine if these women went on to develop breast cancer, only whether they had risk factors that challenged the common notion to wait until 45 for screening, something that should have been better emphasized in the story.
The story didn’t discuss the limitations of risk assessments, nor explain or define what “risk” really means. The headline also overstated the scope of the study. These issues–paired with a lack of information on costs and screening harms–add up to an incomplete story.
Understanding a person’s risk for cancer is beneficial and can help doctors and patients make informed decisions about screenings and care. But given the conflicting information about screening mammography over the past few years, news coverage must take pains not to add to the confusion.
Costs were not discussed in the story. It is not clear if such a breast cancer risk assessment would be covered under insurance if they asked their doctor for such an assessment.
This is the claim of benefit made in the story: “Many women could benefit from earlier mammograms, analysis finds.” But this claim is left unsupported, only describing the number of women at higher risk identified by the study. Of the women identified, what number would actually go on to experience some meaningful beneficial outcome like detection of an invasive cancer, or more importantly, a longer life? Even if the study didn’t dig into those numbers, it’s crucial to explicitly state in the story that the numbers reported don’t reflect the actual number of women who might experience a meaningful benefit–only the number who would be screened.
The story did not discuss potential harms (outside of future breast cancer diagnosis) of women receiving a high score on the risk assessment. It is unfortunate because risk does not mean someone will absolutely get breast cancer and some women could receive false positive mammograms with attendant anxiety and risk of unnecessary follow-up tests and procedures.
There was no information presented that discussed the limitations of such a risk assessment or explained or defined what “risk” really means. The story only discussed how a woman with a higher risk assessment should start mammograms earlier and possibly breast MRIs.
The story would have been more informative if it had explained that the study involved using various risk models, not just a single model. There is well-established variability among the models so a woman may be considered at risk based on one model, but not at risk based on a different model. That variability, coupled with the fact that the study is based on a database review and not uniform use of one risk assessment tool, lessen the quality of the evidence in the study.
Readers can also be misled by a quote in the article. The lead researcher, Dr. Jennifer Plichta, states “We believe formal risk assessment is essential for women ages 40-44 in order to identify those who require screening mammography to start at the age of 40…” Neither Dr. Plichta’s quote or the article makes it clear that the study was not based on formal risk assessment of these patients but simply on a database review.
In the first line of the story it states that “…all women turning 40 should get a breast cancer risk assessment, since half of them may have risks that are high enough to warrant annual mammograms right away.” This sentence alone makes it sound like this risk is in the general population instead of a finding from the study of women visiting a breast specialty clinic.
In addition to mammography-screening mongering, the article states that “the researchers also found that 32 percent of the women met the groups’ eligibility standards for regular screening MRIs, and 25 percent would be eligible for genetic testing.” There is no mention of problems associated with MRI screening or of the significant cost of this screening. Even a co-pay for an MRI can be hundreds of dollars. Eligibility for genetic testing should be determined by a certified genetic counselor, not by a database review.
Only a study authors appear to have been interviewed for the story.
No other alternatives were discussed in the story besides the breast cancer risk assessment. But it seems like there likely are none–you either have the risk assessment or none, so we’ll rate this N/A.
The story mentioned that breast cancer risk assessments are not normally performed in women ages 40-44 years, but didn’t elaborate if breast cancer risk assessments are routinely completed in doctor’s offices or if a woman would need to see a specialist to have one.
Although assessing someone’s cancer risk is not novel, the researchers were trying to make a point that younger women should have their breast cancer risk assessed. From the story it appears that conducting such an assessment in women ages 40-44 would be novel.
But just because assessing all women older than 40 for their breast cancer risk is novel, does not mean it is responsible or should be recommended. The risk assessment tool used is important and the presentation of the results of the risk assessment is crucial for a patient’s understanding of risk. A discussion of a patient’s risk also needs to include the possible harms of screening.
It did not rely on the news release (which quoted a different researcher), and didn’t mislead with the headline from the news release that implied that half of all women between the ages of 40-44 were at risk for breast cancer; however, the first sentence in the story did lead with the misleading line.
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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