Tuesday, January 29, 2013

TALE OF TWO HEADLINES

I planned something else for today's blog but this is in keeping with my dislike of statistics.  I also tend to dislike headlines. Yesterday, the following headlines appeared in my medical news feed:

Lumpectomy Saves Lives In Early Breast Cancer

Lumpectomy May Have Better Survival Than Mastectomy

I can NOT be the only person on the planet who is thinking, "These headlines couldn't possibly be about the same data." And yet, they are.

SAVES LIVES is the way the headline appeared on MedPage Today.

MAY HAVE BETTER SURVIVAL is the way it appeared in Medscape.

You must sign up to access the pages.  It's free but you will need to set up an account and password.  

Bottom line?  Both articles are well written.  The Medscape one digs a bit deeper.  Some important, some VERY important pieces of information should be noted and based upon that information BOTH of those headlines are irresponsible.  They are misleading.  I suppose that will be this week's theme?  Skewing statistics, twisting the truth.... sensationalizing headlines.

Geez..... It's even on a .gov site, a service of the National Institutes of Health.  A direct quote:

"The results of the study: Women were more likely to survive breast cancer if they had the less invasive lumpectomy plus radiation, versus mastectomy and this was the case across all ages."

Ummmmmm.  NOT EXACTLY.....

I'm going to pull out the parts that I feel should be taken into consideration before such broad strokes are painted. Medscape starts one section of the article "Nice Study, But........"  And yes, BUT ..... Medscape reached out to two independent experts for their opinions.  While they were impressed with the study, they "expressed reservations about the findings."  Me, too.

One expert observed that the results seem "counterintuitive" and noted that they may be a reflection of unmeasured variables.  "Unmeasured variables include the use of adjuvant systemic therapy."  In English?  Chemotherapy.  When they analyzed the the data, they looked at the years involved for each of the groups.  It appears those in the mastectomy group were treated at a time when chemotherapy was primarily administered when there were lymph nodes involved.  Advances in chemotherapy are credited for a large part of the mortality reduction over the past two decades.  Another expert said that the absence of data regarding whether or not chemotherapy was administered was "especially concerning."  DAMN right.

Chemotherapy for the lumpectomy patients and not for the mastectomy patients?  Those of us who have had the pleasure of sitting in that chair can attest to the fact that CHEMO COUNTS.  Really?  These data were not included in the observational study??  Then, there was an issue regarding access to care among the mastectomy patients.  There are quite a number of glaring holes in this "observational study" with the splashy headlines that are ONCE AGAIN sending an overtly skewed message.

The researcher who conducted the study and her colleagues "admit that various unmeasured variables were 'likely' to have biased the findings toward higher mortality in women who underwent mastectomy."  And yes, "likely" is in quotes in the article.  REALLY???!!?!?  Ya THINK?????

Don't tell me half a story.  Put it ALL out there.  I'd love to know how much money was spent and the number of resource hours used to put this thing together.  Damn.  This feels like it wasn't even an observational study.  It feels like someone said, "Let's prove that lumpectomy is better than mastectomy and let's find a way to tease that information out of the statistics to show we are right."

If anyone can not log in and wishes to see copies of the articles, send me an email and I will be more than happy to share them with you.

anncicc@gmail.com

Just to pour some gasoline AND fan the flames, this comes on the heels of a study published in Medscape on January 15. The title:

Bias and Spin in Reporting of Breast Cancer Trials

The first sentence reads:

Clinical trial investigators are often biased in their reporting of results from breast cancer studies, and they use spin to emphasize secondary results when the primary end point is not significant.

Emphasis mine.  I can email that one, too.

This whole thing?

It's very disingenuous.  Again.


13 comments:

  1. Wow. It's way past disingenuous - it seems downright irresponsible and lacking in integrity. These are women's lives we're talking about! Decisions get made on such things. It's scary if we're supposed to depend on studies and research and the most access "regular" folks have to such info is via the MSM or sites with some sort of spin/special interest. Thanks so much for pointing this out, will try to circulate.

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    1. MJ,
      Thanks so much for letting me know you saw this..... I think the most important thing anyone faced with decisions regarding a course of treatment is ASK questions. I have been a proponent of understanding options and the risks/rewards/known outcomes associated with all of the choices on the table.

      No one choice is right for every single person. It's essential to have doctors that are willing to explain the options in ways that WE can understand, minus the spin. Show me the data. And make sure I understand it....

      Unfortunately, that is not happening in nearly enough instances and it's very disconcerting. Great doctors don't push an agenda. They are up on all of the latest findings and they take the time to share what's relevant to each patient and to their individual circumstances.

      It's all about informed choices based upon evidence based science. It may not be simple to sort through, but we should not be sold a bill of goods because of information resulting from a "retrospective look back" -- That's not evidence based science. It's merely an observation and in this case, the observation clearly did not include crucial informations which it seems would have been easily incorporated into the findings.

      Thank you again...

      AnneMarie

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  2. I noticed this too when I was putting together all of my breast cancer articles for the day at: http://www.scoop.it/t/breast-cancer-news, and that's why I gather the articles because the are informative but I know that a lot of these reports have failings. I also hate the way you have to register for medscape even though it doesn't cost it's another step my readers have to take to read the article. There are many times more than one article about the same thing and I will try to do with Medical News Today over the other one so people don't have to register to read it. Bottom line is you have to dig deeper with the articles and know what the information is that is going out and decide for yourself what it's significance is. Great observations AnneMarie. Hugs to you, your family ad your mom! XoXoXo - Susan

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    1. Hi Susan,

      Something else jumped into my mind as I was watching everything fly in the twitter stream.... including the NCI tweet touting this "study" ... HOW IN THE WORLD is information from treatment administered TWENTY THREE years ago relevant today. As far as medical time, that's the equivalent of the era of the dinosaurs....

      xoxox

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  3. dear anne marie,

    while we're on the subject, today there is a book review in the NYT's science section, written by abigain zuger, m.d, about "NAKED STATISTICS. STRIPPING THE DREAD FROM THE DATA." by charles wheelan. i found the review well written, made me want to take a peek at the book.

    once again, this post shows your propensity for keen observations and the very relevant questions they elicit. and it points to the exact message that needs to be shouted from roof-tops - the importance of doctors and patients being partners in care, both sides totally PRESENT, to effect the best outcomes.

    hope all is going well for your mom, you and your family,

    much love, XOXOXO

    karen, TC

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    1. Ha! Karen...

      I've been all over the charts today... a few calls and other stuff.... The book? Already downloaded on my iPad. I read about three pages, I'm hooked and I may actually have fallen in love with charlie boy!!

      All quiet up in these parts (especially now that the heat is on!)...

      xoxox
      AnneMarie

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  4. OOPS, THAT'S "abigail zuger", NOT abigain. my apologies to the good doctor and your readers.

    TC

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  5. This kind of thing just makes me crazy. Thanks for digging into it, AM. Could not agree more. xoxo

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    1. Kathi,

      Didn't really take much digging! When the headlines scream like this, there is surely some giant hole in the story.

      I can't wait to see Dr Deanna Attai on the LA local news. I'm trying to queue it up on my laptop to see if I can stream it live!

      Hugs and love....
      AM

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  6. AM, thank you for being my voice! This info is crazy. I heard several people talking about this news. Some of them would not listen to my interpretation, as I tried to explain what was missing in the study. People hear what they want to hear. I have had two survivor sisters die in the past two weeks. Both of them had lumpectomies.....

    Hugs!
    Debbi

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    1. And Deb....

      Headlines sell and the truth falls by the wayside. Pisses Me Off.... But then, that's no surprise to anyone who knows me. I am so sorry to hear about more deaths. It truly is time to change the conversation, isn't it? Maybe it's time to just stop talking and start DOING....

      In a totally unrelated note, I'm not sure I ever shared this with you...... thank you for sitting in the lobby of the Hyatt in DC with our fellow NBCC advocate from South Africa. She is an absolute global powerhouse on twitter and if not for YOU, there would be no connection. I am in awe of her work and every time we have a twitter "chat" I think of you.....

      xoxo

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  7. Always spot on, AM!! I agree with all of your points and adding two observations:

    (1) The timing of this study's release is interesting on the heels of all the pieces of late (including the NYT) condemning the "epidemic" of bi-lateral mastectomies.

    (2) How has no one mentioned the role of radiation in this discussion?? One of my reasons for opting for a mastectomy (and then a bilateral) vs a lumpectomy was to avoid radiation. I didn't want problems down the road if I ever needed more surgery that might require reconstruction. A woman having a lumpectomy does not get the the same survival benefit as a mastectomy -- UNLESS she has radiation. Unless I'm missing something, only rarely do women having mastectomies need radiation -- there are certain circumstances, but as a general rule, it is not needed. So perhaps that is what accounts for a higher survival rate??

    I still think the study is flawed for many, many reasons but that really stood out for me. Sort of embarrassing that the media will do anything for a headline! ; )

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  8. Breast cancer headlines that twist and confuse the facts? Unsurprising. This same thing happened in November when a headlines said "Mammograms Linked With Unnecessary Breast Cancer Treatment". Read first part of article and it says some titillating thing about so many women being treated for cancer that never would have threatened their lives. Only when the whole article is read will the reader learn that there is no way for the doctors to absolutely tell a woman if her cancer needs to be treated or not. I'm not saying this info should not have been made public or that even more research should have been done before going public. I am saying it was presented very, very poorly. As patients, we have to slog through this bullcrap to get the facts, while our (non-cancer patient)friends see the headlines and wonder why we were so worked up about what may or may not have been cancer.

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