text_1: Breast Cancer Drug Breakthrough
text_2: This story reports on a potentially important development in the prevention of breast cancer among high risk, postmenopausal women. The story is clear that this is an existing drug for osteoporosis that has not been approved by the FDA for use in breast cancer prevention. The story also does not make claims about when it may be approved for that purpose. There is no obvious disease mongering; the story accurately represents the prevalence and seriousness of breast cancer  Although there is mention of a clinical trial, the story does not describe the study design. Also not mentioned was the fact that the results have not yet been published or peer reviewed, so interpretation of the clinical significance of these results are difficult at this time. Benefits of treatment are quantified in relative terms only. The viewer is told that raloxifene and tamoxifen both reduce the incidence of breast cancer by about 50%, however there is no context provided for these numbers. Most viewers would want to know “50% of what?” They want the absolute risk reduction. Viewers should have been told that even though the women in the study were high risk, the incidence of breast cancer over 5 years was still very low. The story also does not mention that raloxifene does not reduce the incidence of ductal carcinoma in situ (DCIS, which tamoxifen does), so it is not clear that when the story says the benefits are equivalent between the two drugs, if it will hold true if they include all breast cancer events (including DCIS, which is found quite commonly these days). The story also omits an important fact: the decrease in incidence of uterine cancer and clots in the raloxifene group was not statistically different from the tamoxifen group. Although uterine cancer and blood clots are mentioned as harms of treatment, there is no mention of how often they occur. Other harms such as cataracts and stroke are not mentioned. No costs are mentioned. According to the website for the STAR trial, the cost of Raloxifene is about $75 per month, while Tamoxifen costs about $100 per month. Because these drugs have to be taken for long periods of time, cost is an important issue.