By
Caroline Helwick, Medical Tribune News Service
NEW
ORLEANS -- Women seeking information about their breast-cancer
risk may be misled by statistics from clinical research trials,
according to a specialist in breast cancer risk who called on
scientists to translate statistics into a more meaningful format.
Patricia
Kelly, a medical geneticist at Catholic Healthcare in San Francisco,
said that women generally perceive their risk to be much higher
than it actually is because of the manner in which doctors communicate
such information.
Physicians
should focus less on concepts such as ``relative risk'' or ``percent
increase or decrease in risk,'' Kelly said. Instead, they should
speak in terms of the actual numbers of women who will be affected
and what their risks are for the next year and for the next five
years, she told members of the American Society of Breast Disease
at a meeting here Sunday.
She
applied this logic to the National Surgical Adjuvant Breast and
Bowel Project's Tamoxifen Prevention Trial in women at high risk
for breast cancer. The study found a 49-percent reduction in risk
among women taking the drug tamoxifen. ``This number was impressive
to most people,'' she said, ``but it's the difference between
4.3 cases of invasive breast cancer versus 2.2 per 100 women over
five years time.''
In
considering whether to take this drug, she said, ``My patients
respond very differently to hearing '49 percent reduction' on
one hand, and 'two women per 100 over five years' on the other.
We are talking about extra-small numbers here.''
A
spokesperson for the Louisiana Breast Cancer Task Force praised
Kelley's efforts to encourage physicians at the meeting to communicate
more effectively with women. ``Rather than empowering women, we
are frightening women to death with the statistics,'' said Cathie
McMichael of Slidell, La., a nine-year breast-cancer survivor.
Dr.
Andrew Seidman of Memorial Sloan-Kettering Cancer Center and Cornell
University in New York agreed. ``Physicians have a tremendous
responsibility to make our patients understand the statistics
and how they impact their own lives,'' he said. ``Patients can
also easily be misled by numbers that can pseudo-inflate the benefits
of such strategies as tamoxifen for prevention.''
Seidman
advised physicians to use clear terms to convey risk to their
patients, adding, ``patients considering taking tamoxifen to reduce
their risk for breast cancer need to directly ask their physician,
'What is the absolute benefit in reducing my personal risk, this
year and over the next five years?''
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