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New radiation guidelines for breast cancer: There’s ‘enough’ evidence, HealthDay story states, skirting specifics


4 Star


More Breast Cancer Patients Should Consider Radiation, New Guidelines Say

Our Review Summary

National Cancer Institute

National Cancer Institute

The story addresses new guidelines from the American Society of Clinical Oncology, the American Society for Radiation Oncology and the Society of Surgical Oncology, which say that that some breast cancer patients who would have been unlikely to receive radiation therapy in the past may benefit from radiation treatment. Specifically, the guidance (and the story) focuses on cases in which the patient has had a mastectomy, had small tumors, and in which few lymph nodes are involved.

To fully appreciate these new guidelines, patients and healthcare providers need some basic information that they can use to evaluate the costs and benefits of radiation therapy: How much does it reduce risk of cancer recurrence? How much would it cost? How strong is the evidence behind these guidelines? To varying degrees, the story falls short on these fronts.


Why This Matters

Breast cancer is the most common cancer among women in the United States. According to the CDC, more than 230,000 women (and more than 2,000 men) were diagnosed with breast cancer in 2013 alone. New recommendations related to breast cancer treatment, particularly when coming from three professional organizations, are significant — if for no other reason than because so many people are likely to be affected.


Does the story adequately discuss the costs of the intervention?

Not Satisfactory

Cost is not addressed in the story. That’s problematic because, as the American Cancer Society notes, “treating cancer with radiation can cost a lot.” According to an August 2015 paper in the Journal of Oncology Practice, radiation therapy for breast cancer can cost anywhere from $7,300 to $10,300. That’s a lot of money, and worth noting.

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

Not Satisfactory

Benefits aren’t quantified in the story. In fact, benefits are barely discussed in the story. The story simply notes “the guidelines say there’s enough evidence to show radiation treatment after a mastectomy decreases the risk of breast cancer recurrence.” But how much does it decrease the risk of breast cancer recurrence?  If the benefits aren’t clearly defined, it’s virtually impossible to determine if the costs and risks outweigh them. Granted, the decreased risk of recurrence likely varies widely based on the patient and type of cancer (a point the story makes). But the story would have been much stronger if it had tried to offer more detail on benefits for readers.

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


The story does address the need to “weigh the risks and benefits.” The story notes: “Side effects can include redness of the skin, swelling and skin breakdown severe enough to compromise future breast reconstruction.” Those are important points, and we’re glad the story made them.

We wish the story had also discussed that there can also be more serious health effects from radiation, including the possibility of increased risk of a second cancer. Also, surgical complications may be increased in patients who require radiation therapy.

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

Not Satisfactory

The story tells readers which three organizations issued the guidelines, but it doesn’t tell readers why. The story refers to “enough evidence” and “clear evidence,” but doesn’t tell researchers what that evidence is or where it comes from. Was there one big study on this subject? Three? Nine? Is the guidance based on observational data? Does it stem from decades of observation? The story doesn’t tell us.

Does the story commit disease-mongering?


No disease mongering here.

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


The story cites two experts: One who was involved in crafting the guidelines, and one who was not. More input from independent sources would have made the story stronger, but this is sufficient to merit a Satisfactory rating.

Does the story compare the new approach with existing alternatives?


The story essentially compares getting radiation therapy to not getting radiation therapy (but, as noted above, doesn’t really offer much detail on the benefits of radiation therapy).

Depending on the circumstances, patients who receive post-mastectomy radiation may also be treated with chemotherapy, and we wished that had been discussed, too, since the combination can potentially increase health risks.


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

Not Applicable

The story doesn’t address availability. However, since it is referring to an existing form of therapy that is widely used, we’ll rate this as not applicable.

Does the story establish the true novelty of the approach?


The story does a good job here, explaining that “the new guidelines help clarify what used to be a gray area,” and noting that whether to pursue radiation treatment would still need be to determined on a case-by-case basis by a patient and her (or his) healthcare provider.

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


Since the story includes input from an independent source, it clearly goes beyond what is found in any release related to the new guidelines.

Total Score: 6 of 9 Satisfactory

Comments (2)

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rob oliver

September 23, 2016 at 9:44 pm

Those guidelines drop the ball in addressing the issue of post mastectomy radiation and reconstruction. Radiation makes complications skyrocket in breast reconstruction and potentially commit the patient to more morbid delayed autologous tissue reconstructions. In patients undergoing reconstruction, they need better recommendations to perhaps limit PMRT to only the highest local recurrence groups


    Kevin Lomangino

    September 26, 2016 at 8:00 am


    Thanks for reading and commenting. I’ve provided a reference to support your statement regarding the risk of complications with radiation in breast reconstruction — for readers who may not be familiar with this literature.