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Longer tamoxifen use cuts breast cancer deaths


5 Star

Longer tamoxifen use cuts breast cancer deaths

Our Review Summary

The USA Today story was actually a bit longer than the Associated Press story, so this was not a matter of word count limitations.  In the end, it was a matter of which words were used and how the space was allocated.  But the New York Times story was longest of the three – more than 1,000 words – and put that additional space to good use.


Why This Matters

Once initial treatment for breast cancer is finished, there is a sense of loss of direction for many survivors. There are limited ways to reduce recurrence risk and mortality in the hope of a normal life span.  This research adds to the evidence needed to make good decisions based on scientific study, and in particular adds data for decision-making by premenopausal patients.


Does the story adequately discuss the costs of the intervention?


Price is a significant issue with such a long-term medication and this story covered the issue well.

Does the story adequately quantify the benefits of the treatment/test/product/procedure?


Our reviewers observed:

  • The story helped establish perspective by stating absolute benefits in addition to recurrence risk and mortality.
  • It would have been useful to more clearly state that any benefits appear to be for hormone-positive breast cancers, though the story indicated most premenopausal breast cancers are fueled by estrogen.
  • The quandary for menopausal and post-menopausal patients was appropriately highlighted and useful.

Our reviewers would have appreciated a more specific discussion of some of the age-specific issues in the study, such as those highlighted in a statement released by the Young Survival Coalition to members:

Overall, the patient population in this study tended to have low nodal involvement and most participants were over the age of 45 at time of initial diagnosis.  53% of the 10-year group were node negative and 54% of the five-year group were node negative.  Only 16% of both groups had four or more nodes involved.  Also, only 19% of the 10-year group and 18% of the five-year group were under age 45 at time of diagnosis.  In both the five and 10-year group, 89% of study participants were postmenopausal at time of their entry into the ATLAS trial.  In the five-year and 10-year groups , 47% and 48% of patients respectively had tumor sizes ranging from 1 to 20 mm (equivalent to 2 cm or under), while 39% and 38% respectively had tumor sizes between 21-50 mm (2 to 5 cm).

Does the story adequately explain/quantify the harms of the intervention?

Not Satisfactory

On this criterion, the AP story was not as strong as the competing USA Today story, which noted one woman’s experience with tamoxifen side effects (severe hot flashes, dry eyes, joint pain, weight gain, dryness “that made sex unbearably painful”).

AP only referred to “some troubling side effects” without specifying anything more than endometrial cancer.

The two women with breast cancer – both trained in the evaluation of evidence in the National Breast Cancer Coalition’s Project LEAD training – thought the brief reference to harms could have been more powerful with a reference to the statistics.  “Patients need the facts,” one wrote.  Another of their observations: the story could also have avoided weighting opinion by using the phrase “women balk at taking a preventative drug.”  Making tough choices is one of the tasks of cancer patients.

Does the story seem to grasp the quality of the evidence?


Unlike the USA Today story, this story mentioned that the study had been published in the Lancet.  There were two independent expert perspectives commenting on the evidence in this story – including a quote from an editorial writer in the same journal.  Editorialists’ perspectives are low-hanging fruit which are often ignored in news stories – something we can never understand.

Does the story commit disease-mongering?


No disease-mongering was noted.

Does the story use independent sources and identify conflicts of interest?


A strength of the article is its clear statement of sponsorship of the research, including AstraZeneca, which produces a brand of tamoxifen. USA Today didn’t mention this in its story. The article also indicated possible conflicts of interest among commentators.

Does the story compare the new approach with existing alternatives?


The story adequately discusses and compares alternatives, including aromatase inhibitors Arimidex, Femara, Aromasin.

Does the story establish the availability of the treatment/test/product/procedure?


The article adequately discusses availability.

Does the story establish the true novelty of the approach?


This story clearly presents the study’s importance regarding extended use of tamoxifen .  The drug is not new, but the story clearly reports on its usefulness in particular patients.

Does the story appear to rely solely or largely on a news release?


With multiple sources, it’s clear the story did not rely on a news release.

Total Score: 9 of 10 Satisfactory


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