Mar 252010
 

A few weeks ago I posted some interesting analysis from Steve Kass on the difference between death rates and survival rates when it comes to looking at breast cancer.  Last week FactCheck.org ran an excellent piece debunking an ad that ran before the healthcare vote which mangled breast cancer statistics in a fear-mongering anti-reform pitch. Their reasoning also looks at the difference between survival and mortality rates:

As for breast cancer survival rates, early screening certainly improves those. What’s less clear is whether screening actually improves survival, versus improving the statistics we use to measure it. We’ve written about this a few times before — including in our analysis of a previous misleading ad featuring Walsh.

Walsh’s claim that survival rates for breast cancer are notably higher in the U.S. than in the E.U. is backed up by a study published in the medical journal Lancet, which showed five-year relative survival rates of 83.9 percent in the U.S. and 73.1 percent for the European average. Five-year relative survival rates show the number of cancer patients who are still alive five years after diagnosis, compared with how many people would be expected to be alive in a healthy population. That means that early detection will always improve the five-year relative survival rate — more patients will be alive five years after diagnosis if their cancer is caught early in its course, regardless of whether they ultimately die from the disease. Breast cancer mortality rates — the number of people who died from breast cancer within a given period — are remarkably similar in the U.S. and the U.K., which recommends mammograms every three years starting at age 50.

We talked to a number of experts for our previous article who said that mortality rates were a more accurate statistic for comparing disease outcomes of different countries. The USPSTF’s conclusion is that the improvement in breast cancer outcomes from yearly mammograms starting at age 40 doesn’t outweigh the potential harm associated with the test, mostly harm from potential false positives. Mortality rate comparisons back up that assessment, and survival rate comparisons don’t necessarily challenge it.

Point taken–statistics don’t lie, but the way they are manipulated can be dangerously misleading.

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When it comes to deciding on treatment options with breast cancer (or any other disease) it can get hugely confusing to understand the various statistics in favor of one treatment or another. Steve Kass, an old high-school buddy who now happens to be a professor of mathematics has some thoughtful observations about looking at survival rates and death rates when it comes to breast cancer:

The five-year death rate after mastectomy was 11.5% for women who had both breasts removed. It was 16.3% for those who only had the cancerous breast removed. Adding a contralateral prophylactic mastectomy to the original surgery therefore reduced the five-year death rate from 16.3% to 11.5%. Almost a third fewer mastectomy patients died within 5 years when they had chosen to remove the second (healthy) breast, compared to mastectomy patients who had not chosen to remove the second breast. The bilateral mastectomy decreased the 5-year death rate by 29.4%.

This strikes me as a significant benefit. Suppose I have breast cancer and need a mastectomy. I can choose a single mastectomy and have a one-in-6 chance of dying in five years, or I can choose a double mastectomy and have a one-in-9 chance of dying in five years. One-in-9 sounds quite a bit better to me. If 100,000 women with unilateral cancer need mastectomies, performing 100,000 double mastectomies instead of 100,000 unilateral mastectomies will reduce the number of deaths in the first five years from 16,300 to 11,500. About 4,800 fewer women will die within five years.

The reporting of this study takes a very different viewpoint. It compares the survival rate, not the death rate, and notes that the bilateral prophylactic mastectomy increases the survival rate from 83.7% to 88.5%, “a difference of less than 5%.” Five percent sounds like a small number, but 5,000 lives saved sounds like a large number.

Both statements (lowers by 30%; benefits only 5%) are the same. Only the intent to communicate is different.

The full post is well worth the read.  Being a strong believer in having as much information as possible when facing difficult decisions, thought this was worth passing along.  Also of note, this New York Times blog piece regarding women choosing bilateral mastectomies even when it does not improve their chances for survival.

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