TASK DEFINITION: Generate an explanation for the given claim using the provided supporting material from the paragraph. Please consider the following points while generating an output. 1) The claim will always have supporting proof in the paragraph, and the paragraph will have a clear point of view supporting the claim. 2) There can be instances where direct correlation to the claim is not available. Make use of the sentences in the paragraph to provide a corresponding output supporting the claim. 3) The explanation should be at least one and at most twelve sentences long.
PROBLEM: Paragraph: Costs are mentioned reasonably early in the story, and with specificity. This was good to see. Benefits of these tests are touted, but not quantified. An officer of the National Ovarian Cancer Research Fund Alliance, an advocacy group, testifies that the outcomes of women who have surgery from a gynecologic oncologist “are much better.” But we don’t know what that means. Is it longer survival? Later the story explains that combining the two blood tests with assessment by a clinician “better determined the patients who should be referred to a [gynecological oncologist], identifying well over 90 percent of the women who actually had cancer.”  (Note that this statistic reflects only referral to a gyn-onc, not patient survival.) But how does that compare to the standard assessment tools? A 2016 study described as publication “of the first clinical utility data” demonstrating that use of OVA1 resulted in referral of ovarian patients to gynecologic oncologists offers similar outcomes but is not mentioned in the story. We’re told that experts fear that these tests could lead to unnecessary surgery or delayed diagnosis, and that’s sufficient for a Satisfactory rating. The story could have delved into a bit more of the specifics: What is the evidence for these concerns? What are the false positive and false negative rates? These details are useful because the point of the story is that clinicians are not using these tests to try to improve outcomes of ovarian cancer patients. Are the possible debits–or uncertainties driven by lack of clinical data–contributing to these decisions? There isn’t sufficient information on the evidence behind these tests. The FDA has approved ROMA and OVA1 for use, but the studies that led to that decision are not discussed. Nor is there sufficient discussion of why the physician groups that write guidelines haven’t endorsed the tests. Their concerns are raised, but the evidence is not presented or analyzed. A late diagnosis of ovarian cancer is way too common, and the outcome is grim. At the same time, the anecdotes seem to highlight the sad aspect of the disease without necessarily providing a relevant case in which the tests described would have helped (any more than a basic blood test would have). The companies responsible for developing and marketing these two tests are front and center in this story, with scientists affiliated with the companies clearly identified. At least two sources in the story—one of them a scientist affiliated with the National Comprehensive Cancer Network—appear to be independent of the companies. The story makes it clear that no effective early detection screening test exists. Existing strategies—the CA125 blood test and vaginal ultrasound—are mentioned and then discounted, in part via a personal narrative of a young woman who received a late diagnosis of cancer. While data-driven specifics aren’t included on why standard methods aren’t sufficient, this is enough to rate Satisfactory. A direct comparison of survival stemming from existing diagnostic tests relative to survival stemming from ROMA and OVA1 would have strengthened the story. If those numbers aren’t available, that should have been pointed out. The story makes it clear that the two blood tests have been available since 2009. The story mentions that the tests are combinations of existing tests with a “proprietary” formula (essentially a risk prediction tool) to translate the results to likelihood of cancer. But, the article should have talked about whether the tests, other than CA-125, have been used before. This appears to be an enterprise story, and does not rely on a news release. Claim: Ovarian cancer blood tests: Available, not widely used

SOLUTION: This is a story about the apparent underuse of two blood tests—ROMA and OVA1—that are FDA approved to help clinicians decide whether surgery to investigate abnormal growths should be performed by a gynecologic oncologist (“gyn-onc”) trained to remove malignant ovarian cancer, rather than an obstetrician-gynecologist or a general surgeon. The gist of the story is that the tests have not been widely adopted in the ensuing years, “largely because they haven’t been recommended by the physician groups that write the care guidelines.” The story hit on a lot of important notes–it told readers the cost of these tests, and it included comments from independent sources. What is not clear is the extent to which clinical evidence supports the increased use of the two tests. We’re told they accurately picked up about 90 percent of cancer cases. But we’re not told how that compares to standard methods of detection. As the story notes, surviving ovarian cancer is an uphill battle–it is often a deadly disease caught too late. Any procedure that increases the probability of survival is worth careful consideration.

PROBLEM: Paragraph: The article did not discuss costs. Screening mammograms impose a significant cost on the U.S. health care system and insurers, particularly Medicare. The story detailed the relative harms of earlier mammograms, but did not translate those percentages into absolute numbers. For instance, women who were diagnosed with breast cancer 25 months or more after their last mammogram were “50 percent more likely” to need chemotherapy, “32 percent more likely” to need mastectomy, and “66 percent more likely” to need lymph nodes removed. However, relative risk can be misleading, sometimes inflating numbers to sound scarier than when absolute numbers are used. Also, we don’t know what kind of risk these women had at baseline, so it’s hard to know if they were higher risk. The story made no mention of the harms of earlier or more frequent screening, which have been documented time and time again. More screening can mean more false positives or more finding of breast changes that lead to more testing, such as biopsies, more costs, and more worry. The story did make clear some of the weaknesses of the study: The study found an association but did not prove causality and the study population was limited to a single health care institution. The story also mentions that the findings were presented at a meeting, which means they have not undergone peer-review. The story does not directly engage in fear-mongering. However, some of the quotes advocating for earlier and more frequent screening play into a scenario that breast cancer is lurking in every woman. A discussion of what a woman’s average lifetime risk is would have been helpful. The story quotes the study author and an outside source. The story makes clear that different advisory groups have differing guidelines for what age to start getting mammograms (40 or 50 years old). It would have been nice if the story had included examples of what makes someone higher risk or not (personal cancer history, family history, history of radiation), but we think this was satisfactory. We believe that mammograms are well-known to be widely available. And the earlier and more frequent screening described here is not earlier or more frequent than what many guidelines recommend, so would not be expected to be denied by health insurers. The story makes clear the distinctive aspects of this study —using avoidance of more aggressive treatment regimens as a deciding factor, as opposed to the more extreme avoidance of cancer death. The story goes beyond what was contained in a news release on the presentation at the American Society of Breast Surgeons annual meeting. Claim: Earlier Mammograms May Mean Less Need for Aggressive Treatments

SOLUTION: This HealthDay news story reports on findings among women diagnosed with breast cancer: those who had longer intervals between mammograms end up getting more aggressive treatments, including chemotherapy and surgery. The story would have been stronger had it described the findings using absolute rather than relative numbers. But, we were glad to see an independent source offer some reservations about the small observational study raised. A final note — the image accompanying the story was laughably unrealistic. Mammograms are the primary screening method for detecting breast cancer. However, when to start getting mammograms and how often to get screened have been subjects of controversy for the past decade. That’s because the data on how to balance risk of developing breast cancer and the risk of harms from screening (unnecessary tests and procedures) are interpreted differently by doctors and other experts. A story that adds new data to the field and that might tip current guidelines one way or the other is newsworthy.

PROBLEM: Paragraph: "At this early phase of research it’s understandable that cost wouldn’t be discussed. It provided the outcomes in absolute terms – which we appreciate:  ""Of 8,197 people who got vaccine, 51 became infected in the three years after their shots. Of the 8,198 who got placebo injections, 74 became infected. While that difference — 23 infections out of more than 16,000 people studied — is significant, it could have occurred by chance."" Were any harms – besides the lack of protection in most trial participants – reported in the Thai trial? We don’t know from the story. This is the strength of the story – by itself and in comparison with many other stories by many other news organizations. Over and over and throughout the story, the evidence was questioned. Excerpts: Other researchers were less sanguine about the study but did not want to be quoted by name as being skeptical when only a few details of the results have been released. ""I just think it’s too early really,"" said one, who spoke on the condition of anonymity for that reason. ""It is in a kind of gray zone, and I think we should really get the data and look at it and see what it all means."" And there was more. You get the picture. No disease-mongering in this story. Interviews with Dr. Fauci of NIH, with one of the investigators, and with an unnamed skeptic. Good job comparing this vaccine approach with other vaccines. The experimental stage of the vaccine research is clear from the story, as when it states: The vaccine is not licensed or being produced in large amounts. It is unlikely — but not impossible — that any country would consider it effective enough to be used as a public health measure against HIV. The story gave lots of detail about the novelty of this approach, but questions: ""How a vaccine that induces both a weak antibody response and a poor cell-mediated one can protect some people from HIV infection is the big initial mystery of this study."" It is abundantly clear that this story did not rely on a news release, but, rather, was based on enterprise journalism with context and with a historical perspective." Claim: Scientists Puzzle Over Minor Success Of AIDS Vaccine

SOLUTION:
While many other news organizations were calling a Thailand AIDS vaccine trial a breakthrough, this story provides caveats, some skepticism, loads of context, comparisons with other vaccines and historical perspective. You can read the criterion by criterion analysis below, but this is the way early announcements of experimental research results should be covered. Kudos to David Brown and to the Washington Post.