Correction to This Article
A May 10 Health section story about a study exploring aspirin use and breast cancer prevention incorrectly labeled hormone receptor positive cancers the most dangerous kind. That description applies to hormone receptor negative breast cancers.

Overstating Aspirin's Role In Breast Cancer Prevention

By Lisa M. Schwartz, Steven Woloshin and H. Gilbert Welch
Special to The Washington Post
Tuesday, May 10, 2005

Medical research often becomes news. But sometimes the news is made to appear more definitive and dramatic than the research warrants. This series dissects health news to highlight some common study interpretation problems we see as physician researchers and show how the research community, medical journals and the media can do better.

Preventing breast cancer is arguably one of the most important priorities for women's health. So when the Journal of the American Medical Association published research a year ago suggesting that aspirin might lower breast cancer risk, it was understandably big news. The story received extensive coverage in top U.S. newspapers, including The Washington Post, the Wall Street Journal, the New York Times and USA Today, and the major television networks. The headlines were compelling: "Aspirin May Avert Breast Cancer" (The Post), "Aspirin Is Seen as Preventing Breast Tumors" (the Times).

In each story, the media highlighted the change in risk associated with aspirin -- noting prominently something to the effect that aspirin users had a "20 percent lower risk" compared with nonusers. The implied message in many of the stories was that women should consider taking aspirin to avoid breast cancer.

But the media message probably misled readers about both the size and certainty of the benefit of aspirin in preventing breast cancer. That's because the reporting left key questions unanswered:

· Just how big is the potential benefit of aspirin?

· Is it big enough to outweigh the known harms?

· Does aspirin really prevent breast cancer, or is there some other difference between women who take aspirin regularly and those who don't that could account for the difference in cancer rates?

This article offers a look at how the message got distorted, what the findings really signify--and some broader lessons about interpreting medical research.

How Big a Benefit?

Just how big is the potential benefit of aspirin?

The 20 percent reduction in risk certainly sounds impressive. But to really understand what this statistic means, you need to ask, "20 percent lower than what?" In other words, you need to know the chance of breast cancer for people who do not use aspirin. Unfortunately, this information did not appear in any of the media reports. While it might be tempting to fault journalists for sloppy, incomplete reporting, it is hard to blame them when the information was missing from the journal article itself.

In the study, Columbia University researchers asked approximately 3,000 women with and without breast cancer about their use of aspirin in the past. The typical woman in this study was between the ages of 55 and 64. According to the National Cancer Institute, about 20 out of 1,000 women in this age group will develop breast cancer in the next five years. Therefore, the "20 percent lower chance" would translate into a change in risk from 20 per 1,000 women to 16 per 1,000 -- or four fewer breast cancers per 1,000 women over five years.

For people who prefer to look at percentages, this translates as meaning that 2 percent develop breast cancer without aspirin, while 1.6 percent develop it with aspirin, for an absolute risk reduction of 0.4 percent over five years.


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