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CancerInTheNews:BiasAndQualityInMediaReportingOfCancerResearch.
AmandaAmberg,DarrenN.Saunders.
SchoolofMedicalSciences,UniversityofNewSouthWales,Sydney,NSW2052,Australia.
Correspondence:
Assoc.Prof.DarrenSaundersSchoolofMedicalSciencesUniversityofNewSouthWalesSydney,AustraliaPhone:+61293852494Email:[email protected]
Keywords:cancer,research,communication,bias,gender,media
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Amberg&Saunders–Biasincancerresearchreporting
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Abstract
Cancer research in the news is often associatedwith sensationalising and inaccurate reporting,
giving rise to false hopes and expectations. The role of study selection for cancer-related news
stories is an important but less commonly acknowledged issue, as the outcomes of primary
research are generally less reliable than those of meta-analyses and systematic reviews. Few
studieshaveinvestigatedthequalityofresearchthatmakesthenewsandnopreviousanalysesof
theproportionsofprimaryandsecondaryresearchinthenewshavebeenfoundintheliterature.
Themainaimofthisstudywastoinvestigatethenatureandqualityofcancerresearchcoveredin
online news reports by four major news sources from USA, UK and Australia. We measured
significantvariationinreportingquality,andobservedbiasesinmanyaspectsofcancerresearch
reporting,includingthetypesofstudyselectedforcoverage,andinthespectrumofcancertypes,
genderofscientists,andgeographicalsourceofresearchrepresented.Wediscusstheimplications
ofthesefindingforguidingaccurate,contextualreportingofcancerresearch,which iscritical in
helping thepublicunderstandcomplex scienceandappreciate theoutcomesofpublicly funded
research,avoidunderminingtrustinscience,andassistinformeddecision-making.
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Introduction
Canceristhesecondleadingcauseofdeathglobally,accountingfor8.8milliondeathsin2015[1].
ThetotalannualeconomiccostofcancerwasestimatedatapproximatelyUS$1.16trillionin2010
[2]anditisestimatedthat30-50%ofcancerdeathscouldbepreventedbymodifyingriskfactors
including tobacco exposure, alcohol consumption, obesity, exercise and infection [3]. Cancer is
complexandchallengingtostudy,andnewsreportingoncancerresearchissusceptibletohype,
contradictionandmisinformation.Clearlycommunicatingtheoutcomesandcontextofresearchis
key to helping non-specialists understand complex science, and assisting patients and families
make informeddecisions aboutmodifying risk and treatment selection. Poor reporting practice
may have serious consequences for public and scientific communities alike, including the
generationoffalseorunmetexpectations,potentiallyfuellingdisappointmentandalossoftrust
inscience[4,5].
Few studies have focused on quantifying the types and quality of scientific research that gain
attentioninthenews,whichisarguablyasimportantasaccuratetranslationofresearchpaperto
newsstory.Evenanewsreportthatperfectlydescribesthefindingsofastudyisoflittlevalueto
thepublicifthefindingsthemselvesarebasedonweakevidence.Further,thereliabilityandlong-
termimpactofprimaryresearchisrarelyknownatthetimeofpublication.Incancerresearchand
otherfields,ithasbeendemonstratedthatinitiallyreportedeffectsizestendtobenotablylarger
thanthosepublished insubsequentmeta-analysesandthatastrikingproportionofpublications
will be refutedby follow-up studies [6-8]. ThisphenomenonwashighlightedbySchoenfeldand
Ioannidis in theirmeta-analysisondietary riskandpreventionof cancer [9].News reportingon
cancerresearchhaspreviouslybeenassociatedwithpooraccuracy,sensationalisingheadlinesand
presentation of conflicting information [10]. A preference towards reporting novel primary
researchstorieswithlowreplicationlikelihoodoftenresultintherefutation(orfailedreplication)
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of a research finding getting significantly less attention than the initial finding itself [11],
reinforcingan‘asymmetryofbullshit’[12].
Previousanalyseshaveobserved that thedistributionofnews storiesby canceranatomical site
mirrorsincidenceratesmorecloselythanmortalityratesbutthatcertaincancertypeswereover-
orunder-represented.Thesedistortions,potentiallydrivenbypersonalisationbias(e.g.,celebrity
profiles)were also reflected in riskperceptionanddiscrepancies in funding for cancer research
[13-15]. Others have also documented variation in quality, topic coverage and style of cancer
researchreportinginprintmedia[16-18].Previousresearchinvestigatingthequalityoftranslation
from research papers and press releases to news stories highlights widespread problems with
inadequatereferencinganddistortedreporting[19-24].Whilethetabloidor ‘popularpress’was
themainculprit,thesameissuesalsoexistinthemoreprestigiousbroadsheetnewsoutlets[20,
25].Itmaybetemptingforresearchers,journalists,philanthropicbodiesandresearchinstitutions
to sensationalise scientific findings in their pursuit of funding, readers or publicity. A common
consequence of poor quality reporting is a hype cycle characterised by false expectations and
subsequentdisappointment[4].Hypemaybegeneratedbyjournalists,institutionalpressreleases,
orthescientiststhemselvesandcanthenbeamplifiedthroughthemediacycle[21,26].
Primary research more easily lends itself to ‘breakthrough’ headlines since, by definition, it
presents original data. Quality and reliability are not intrinsic features of meta-analyses and
systematic reviews but depend on appropriate systematic methods [27, 28]. Nevertheless, the
natureandpurposeoftheseformsofsecondaryresearch–collating,comparingandre-analysing
a set of primary studies to reduce uncertainty – render them less susceptible to error than
individual primary studies [7]. Based on this assumption, secondary research is an important
source of science news for the general public, yet there are indications of a reporting bias
favouring primary studies [29]. In academic publishing, peer review and the accumulation of
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primaryresearchpapersfollowedbymeta-analysesandreviewarticlesaredesignedtohelpfilter
inaccuracies of individual study outcomes but there is no equivalent formalised system in the
newsmediabeyondstandardeditorialoversight.Analysisof734front-pagestoriesaboutmedical
researchinmajornewspapersfoundthatjustoverhalfwerebasedonpaperspublishedinpeer-
reviewedjournals,aminorityofthesebeingsystematicreviews[29].Thisemphasisestheneedfor
bettercharacterisationofthetypesandqualityofcancerresearchstudiesthatgainattention in
thenews.
Hence,thisstudyaimedtoanalyseselectionbiasandqualityofcancerresearchpublishedinfour
majornewssourcesfromtheUK,USAandAustraliaoverasix-monthperiodin2017.
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Methods
Newsreportcollection
Twentynewsreportsweresampledfromeachoftheonlineversions(publishedbetweenMarch
andSeptember2017)ofTheGuardian (UKedition),TheNewYorkTimes (NYTimes),TheSydney
Morning Herald (SMH) and the Australian Broadcasting Corporation (ABC), generating a total
datasetof80reports.Thefollowingsearchtermswereusedwithinthesearchfunctiononeach
source’s website: ‘cancer study’, ‘cancer research’, ‘cancer science’, ‘targeted therapy’, ‘cancer
screening’, ‘cancer screening study’, ‘tumour research’, ‘tumor research’, ‘cancer treatment’,
‘cancergenetics’and‘cancerscientists’.Onlyoriginalreportswereincludedinthesample,reports
re-publishedfromothernewssourceswereexcludedtoavoidoverlapinthedata.Thereportshad
to discuss a study investigating a cancer-related issue including epidemiology, carcinogens,
screening, diagnostics, therapies, basic biology, risk or prevention. General reports which dealt
withcancer-relatedtopicsbutwhichdidnotbasethediscussiononaspecificstudywereexcluded.
Whenseveralstudieswerediscussedandnoonecentralstudycouldbedistinguished,thereport
was excluded. Details of individual reports (including Pubmed ID (PMID), quality scores and
hyperlinkstoreports)arecontainedinSupplementaryTable1.
Classificationandscoring
Where possible, the study discussed in each media report was traced and classified as basic
research,clinicalresearch,epidemiologicalresearch,meta-analysisorsystematicreviewaccording
to the classification of Röhrig et al. [30]. Original research sources cited in news reports were
classified as either published paper, conference, report, press release, pre-print article, funding
source/researcherorunknown.News reportqualitywas scoredaccording toamatrixbasedon
elevencriteriaadaptedfrompreviousstudies(Table1)[19,21].Australiancancer incidenceand
mortalitystatisticswereobtainedfromtheAustralianInstituteofHealthandWelfare[31].Gender
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ofseniorauthors(i.e.namesappearinginfirstandlastpositiononauthorlist)andquotedexperts
in each report was also quantified using pronouns quoted in reports or on homepage. Source
nationalitywasclassifiedaccordingtoprimaryacademicaffiliationofcorrespondingauthors.
Dataanalysis
Chi-square or Fischer’s exact tests were used to compare the categorical variables (primary or
secondary study), assuming statistical significance if P<0.05. Quality scores were aggregated
according to Table 1 andmean scores calculated. Statistical significance of differences inmean
scores between the news sources was tested using one-way ANOVA, assuming Gaussian
distribution,formultiplecomparisonswithaTukeytest.Whenanalysingnationalbias,allstudies
that had been conducted as international collaborations were included in the ‘international’
category.
Table1.NewsReportQualityScoringCriteria.
Criterion Scoring Notes
Peerreviewedresearchsource 0,3(no,yes) Peerreviewwasassignedaheavierweightingthanotherbinarycriteriatoreflectimportance.
Conflictsofinterestorfundingsourceidentified 0,1(no,yes) Conflictsofinterestorfundingsourceshadtobementionedinthenewsreporttomeetthiscriterion.
Independentexpert(s)quoted 0,1(no,yes) Independentexpertsmustnotbeaffiliatedwiththepaper,publishingjournal,researchinstituteorfundingbody.
Linktoresearchsource 0,1(no,yes) Linksmustleaddirectlytotheresearchsource(publishedpaper,conferenceabstract,etcetera).Linkstojournalhomepagereceived0forthiscriterion.
Traceableresearchsource 0,1(no,yes) Enoughinformationprovidedtoallowtracingthesourcewithin5min.
Studylimitationsidentified 0,1(no,yes) Requiredmentioningalimitationofthestudy’smethod,evidence,conclusionorimplications.Generalstatementsaboutwhatthestudydidnotaimtoinvestigatewerenotsufficienttofulfilthiscriterion.
Placedstudyinbroaderresearchcontext 0,1(no,yes) Thereportshouldrefertorelatedknowledgeortheoriesgeneratedbyresearchersunaffiliatedwiththestudyinfocus.
Absoluterisksorbenefitsquantified 0,1(no,yes) Risksandbenefitspresentedbyastudyshouldbedescribedinabsolutenumbers.Percentagesortotalincidencedidnotfulfilthisrequirement.Thiscriterionwasnotapplicabletosomereports.Forthese,thetotalscoreswereadjustedasaproportionofthemaximum:(assignedscore÷16)×17.
Misleadingheadline 0,1(yes,no) Thisincludedsensationalising,incorrectorotherwisemisleadingheadlines.
Emphasismaintained 0-3 Themainaims,outcomesandimplicationsaspresentedinthestudyshouldbemaintainedintheheadlineandbodyofthenewsreport.Thescoringrangewasasfollows:emphasismaintainedinneitherheadlinenorbody(0),ineitherheadlineormostofbody(1),inbothheadlineandmostofbody(2),inbothheadlineandallofbody(3).
Avoidedovergeneralisation 0-3 Overgeneralisationcouldrefertosamplepopulations,thetargetsofatreatmentorotheraspectsofthestudydependingonitsclassificationandtopic.Scoreswereallocatedasfollows:bothheadlineandbodyovergeneralising(0),eitherheadlineorbodyovergeneralising(1),headlineandbodymostlyavoidedovergeneralisation(2),headlineandallofbodyavoidedovergeneralisation(3).
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Results
Contentbias
The long-term implications of primary research findings are rarely known at the time of
publication. Indeed, while basic research is absolutely essential to scientific progress, there is
evidencethataremarkableproportionofpublishedresultswillberefutedbyfurtherinvestigation
or that subsequent meta-analyses will report notably smaller effect sizes, in cancer as well as
otherresearchareas[6-8].SchoenfeldandIoannidis[9]publishedameta-analysishighlightingthis
phenomenon in research on cancer risk and prevention. Similar trends have been observed in
basicmedicalresearch,whereonlyasmallfractionofthemostencouragingearlyfindingsendup
inclinicaluse[32].Thisbecomesimportantwhenscientificresearchpapersgainattentioninthe
mainstream press, the predominant source of science news for the public. However, there is
limitedliteratureoncontentbiasinsciencenewsreporting.Qualityandstylehavebeenshownto
varyacrossnewsoutlets[16,17],buteventhelargestnewspaperswiththebestoverallstandards
tend to cover more studies with poorer methodology and observational studies over RCTs or
systematicreviews[33-35].
Toinvestigatethedistributionofdifferentstudytypesincancerresearchreporting,wequantified
thenumberofprimaryandsecondarystudiesandtheirsubtypes inasampleof80newsstories
from4differentoutlets.Ofthesamplesreports,92.5%(74/80)werebasedonprimaryresearch
studies (Fig. 1a).When studieswere further classifiedby subtype, epidemiological studieswere
themostprevalentoverall,accountingfor38.75%ofreports(31/80),followedbyclinicalandbasic
researchat28.75%(23/80)and23.75%(19/80)respectively(Fig.1b).Secondarystudiesconsisted
of four systematic reviews and twometa-analyses (Fig. 1b).One studydidnot fit in anyof the
categoriesandwasthereforeclassifiedas‘other’.
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Figure 1. Study type bias represented in online news reports about cancer: A. Frequency ofprimary and secondary research represented in online news reports about cancer research. B.Distributionofresearchsubtypesrepresentedinnewsreports(n=80).
Wenextclassifiedandquantifiedthesourceof researchstudiescited inoursampleof80news
reports. Most news reports (68.75% or 55/80) were based on peer-reviewed papers (Fig. 2),
sometimesaccompaniedbyapress release.Researchpublishedoutsideof traditional academic
journals (e.g. reports issued by government agencies)were the basis of 12.5% (10/80) of news
items, and 10% (8/80) of reports were based on conference presentations (five of these were
publishedconcurrentlywithamajorannualcancerconference).Twonewsreportswerebasedon
institutional press releases without an associated published scientific paper, and two others
referredonlytotheresearcherorfundingsource.Thesourceofthreenewsreportscouldnotbe
traced(Fig.2).
Epidemiologica
l
Clinica
lBas
ic
System
atic r
eview
Meta-an
alysis
Other0
10
20
30
40
Num
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orts
Primary
Secondary
0
20
40
60
80
Num
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Amberg - Figure 1.CC-BY-NC-ND 4.0 International licenseavailable under a
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Amberg&Saunders–Biasincancerresearchreporting
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Figure2.Distributionofresearchtypesformingthebasisofonlinenewsreportsaboutcancerresearch(n=80).Cancertypesrepresentedinreporting
We examined the distribution of cancer types (defined by anatomical site) represented in our
cohortof80newsreports.Themostfrequentcategoryobservedwasnon-specific(i.e.notrelated
toaspecificcancertype),representing18/80(22.5%)reportsandpossiblyreflectingastrongbias
towards more basic research on disease mechanisms and risk. Among cancer types explicitly
identifiedinnewsreports,breast(15%),melanoma(11.3%),lung(8.8%)andblood(8.8%)cancers
werethemostfrequentlyreported(Figure3a).Reportsspecificallymentioninggastric,testicular,
brainandpancreascancerweretheleastfrequentlyobserved,witheachonlybeingrepresented
inasinglereport.Manycancertypeswerenotrepresentedinnewsreportsatallduringsample
period.Whenanalysedinthecontextofrelativeratesofincidenceandmortalityofspecificcancer
types,weobservedastrongcorrelationbetweenreportingandincidenceofspecificcancertypes
(R2 = 0.594, p=0.0013) but not with mortality (Figure 3b,c). Research on cervical cancer was
reported more frequently than would be expected relative to incidence, while prostate and
Published
pap
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Confere
nce
Report
Press
relea
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Funding so
urce/r
esea
rcher
Unknown
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20
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60
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repo
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Amberg - Figure 2 .CC-BY-NC-ND 4.0 International licenseavailable under awas not certified by peer review) is the author/funder, who has granted bioRxiv a license to display the preprint in perpetuity. It is made
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Amberg&Saunders–Biasincancerresearchreporting
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colorectal cancer were under-represented in news reports (Figure 3b). Relative to mortality,
cervical,melanomaandbreastcancerwereover-represented,whilelung,pancreas,andcolorectal
cancerwereunder-represented(Figure3c).
Fig3:Analysisofbiasincancertypesreported.A.Distributionofcancertypesinresearchstudiescoveredinnewsreports,withAustralianincidenceandmortalityrates;Reportingfrequency(asaproportionoftotal)comparedwithrelativeincidence(B)andmortality(C).
Amberg - Figure 3
A
B C
non-spec
ificbrea
st
melanoma
lungblood
prosta
tece
rvix
colorec
tal liver
uterus
ovaria
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gastri
c
testic
ularbrai
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pancre
as0
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0
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Incidence / mortality (total)
incidencemortality
0 5 10 150
5
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Incidence (%)
repo
rting
(%)
prostatecervix
colorectal
0 5 10 15 200
5
10
15
20
Mortality (%)
repo
rting
(%)
breast
melanoma
lungcervix
colorectal
pancreas
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Reportingquality
News reporting of research is of most value to readers if it accurately conveys the outcomes,
contextandimplicationsoftheresearch.Particularlyinthecontextofseriousdiseaseslikecancer,
accurate reporting is critical for informing decisions on modifying risk, choice of intervention,
understandingprognosis,etc.The levelofconsensusbetweennewsarticlesandrelatedoriginal
researchpapersasamarkerofaccuracyhasbeenthefocusofextensiveresearch.Almostthree
decadesago,Singer [19]proposedananalyticalmodel for scoringaccuracywithelevencriteria,
including issues of incorrect statements, misleading headlines, sensationalisation and
overgeneralisation,andthesehavebecomebenchmarksforevaluatingqualityofmediareportson
research.ModifiedversionsofSinger’smethodhaverevealedpoorcitationpracticeandfrequent
misleading reporting in the news [22-24]. Although the tabloid press is the biggest culprit in
misinterpreting science news, studies have demonstrated that a lack of quality also exists in
broadsheetnewspapers[20,25].Today’sonlineenvironment isthoughttoresult inmanymajor
newsoutletsutilisingthesamesourcesofinformation,potentiallyresultinginanamplifiedspread
of poor quality reporting [36]. Research institutes and funding bodies seeking publicity and
philanthropic supportmay exploit this space as press releases play amajor role in shaping the
contentofmanynewsarticles[21].
WemeasuredreportingqualityinourcohortusingascoringmatrixmodifiedfromSinger[19]and
Taylor[21]forcomparisonbetweenvariousnewsoutlets(Table1).TheNYTimeshadthehighest
averagequality score (12.9),while the lowest average scoreswere seen in theAustraliannews
sources (9.5 and 8.8 forABC and SMH respectively), with reports in The Guardian averaging a
qualityscoreof11.2 (Fig.4).Reports intheNYTimesalsodisplayedthemostconsistentquality
scores, although there was variability in quality observed in all news sources. Where online
readership statistics were available (i.e. for the 20 studies published by ABC), we observed no
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relationship between reporting quality and readership (not shown). Similarly, we observed no
obviousrelationshipbetweenstudytypeandreportingquality,butthelownumberofsecondary
studiesreportedlimitedthisanalysis.
Figure4.Qualityscoresofnewsreportsoncancerresearch.Eachpointrepresentsthescoreofanindividualnewsreport.Barsindicatethemean+SEMforeachnewsoutlet(n=20foreach).
Nationalbiasinreportingofcancerresearch
While research performed in theUSA dominates scientific output in terms of papers published
[37],reportingonresearchinalocalcontexthasimportantimplicationsforbothconsumersand
scientists alike. Different risk factors may have proportionally different significance for various
audiencesanditiscriticalthatscientistsareabletoreachthemostrelevantaudiencesontopics
of local importance.Forexample,understandingtheroleofUVexposureinmelanomarisk isan
important consideration in Australia. Further, it is important for both scientists and consumers
aliketohaveoutcomesofpubliclyfundedresearchcommunicatedtotaxpayers.
Guardian
NYTimes
SMHABC
0
5
10
15
20
Qua
lity
scor
e
P=0.0373
P<0.0001
P=0.0012
Amberg - Figure 4
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To analyse national bias in cancer research reporting, we analysed the country of origin of
researchcited ineachnews report -determinedby theprimaryaffiliationof thecorresponding
author of the research publication (where available). At least half of the reports in each news
sourcewerebasedonresearchfromthesamecountryinwhichthenewsorganisationwasbased
(Fig.5).TheGuardian(UKedition)hadthemostdiversenationaloriginofresearchcited,withonly
50%ofreportsbasedonresearchperformedprimarilyintheUK.Incontrast,70%ofreportsinthe
NYTimeswerebasedonresearchstudiesperformedprimarilyintheUSand72.5%ofAustralian
newsreportswerebasedonAustralianresearch(65%and80%bySMHandABC,respectively)(Fig.
5).Viewedfromtheoppositeperspective,thegreatmajority(29/30studies,or97%)ofAustralian
researchstudiesrepresentedinourcohortwereonlyreportedinAustraliannewsoutlets.Inother
words,only1/30Australianstudiesreceivedinternationalcoverage(Fig5).
Figure 5. National bias in reporting of cancer research. Sankey chart showing relationshipsbetweencountryofresearchorigin(left)tocountryinwhichreportingnewsorganisationisbased(right), with bar sizes representing proportional representation. The UK is represented by TheGuardian,USAbyNYTimesandAustraliabySMHandABC.
Amberg - Figure 5
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Genderbiasinreportingofcancerresearch
Female scientists face a suite of documented biases [38-41], and a number of studies have
established that women are under-represented in news media [42, 43]. More specifically, the
systematicunder-recognitionof femalescientists–knownastheMatildaeffect [44]–hasbeen
demonstrated in science communication,where publications frommale authors are associated
with greater perceived scientific quality [45]. Across our entire cohort of 80 news reports, we
observedasignificantgenderbiasamongseniorauthors,with60%(67/112)of researchstudies
reported havingmale senior authors (Fig 6a).We also observed a significant bias towardmale
expertsbeingquotedinnewsreports,with68%(100/148)ofquotedexpertsbeingmale.Asimilar
trend was observed in individual news outlets, with the exception of the ABC - where equal
representationofmaleandfemaleseniorauthorswasobservedinthestudiesformingthebasisof
news reports (Fig 6b). The bias towards quoting male experts in online reports about cancer
researchwasconsistentacrossindividualnewsoutlets(Fig6c).
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Figure6.Genderbiasinseniorauthorsandquoted experts in news reports.Distribution of senior authors and expertsacross the entire cohort (n=80), anddistributionofauthors(B)andexperts(C)inindividualnewsoutlets(n=20each).
authors experts0
50
100
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overall
male
female
ABCSMH
NYT
Guardian
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Amberg - Figure 6
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C
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Amberg&Saunders–Biasincancerresearchreporting
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Discussion
Clear communication of research outcomes in context is important in helping non-specialists
understandtheoftencomplexandchallengingcontentsofscientificpublications.Poorreporting
may hinder informeddecision-making aboutmodifiable risks and treatment selection, generate
falseorunmetexpectations,andunderminetrustinscience[4,5].Inordertobetterunderstand
factors influencing reporting of cancer research we analysed the distribution of study types,
researchsources,reportingquality,genderbias,andnationalbiasinonlinenewsreportsbyfour
majornewsoutletsinUSA,UKandAustraliaoverasix-monthperiodin2017.
Our analysis demonstrated that primary research studies predominate over secondary studies.
Thismayreflectasimilartrendinthepublicationfrequencyofthesestudytypes–bytheirnature,
systematic reviews and meta-analyses are less abundant than primary studies – or the way
institutespromotetheirresearch.Further,evidenceofaskewtowardslowerqualitystudiesinthe
news [33] indicates thatpublicationbiasmightbeanunderlying factor innewspapers favouring
researchwithpoorermethodology.Similartrendshavebeenobservedinotherpublications,with
observational studies on average receiving more attention than both systematic reviews and
randomised controlled trials (RCTs) [34, 35]. This is problematic as the features thus attracting
media attention are often a key driver of hype, confusion and false expectations. Hence, our
observedbiastowardsreportingprimarystudiesmayincreasetheriskofgeneratinghypeabout
cancerresearchvianewsreporting.
Whensearchingfornovelstories,journalistsarelikelytofavourprimaryresearchfindingsdueto
their novelty and frequently larger effect sizes [7] but basic research articles are also themost
susceptible to sensationalisation [36]. While experienced scientists and many journalists likely
know to view these papers as potentially useful pieces in a much greater puzzle, the general
populationmay not have the experience or specialist knowledge to interpret individual reports
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Amberg&Saunders–Biasincancerresearchreporting
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criticallyinabroadercontext.Despiteblamecommonlybeingattributedtojournalistsandpress
releases,statementsintheresearcharticlesthemselvesareoftenexaggeratedandmaygenerate
hype.Forexample,manyobservationalstudies inhigh impact journalscontainadviceonclinical
practicewithoutmentioningtheneedforconfirmationbyRCTs[26]orfailtodiscusspopulation
biases,smallsamplessizes,ordifficultiesintranslatinganimalstudiestohumans.
The lowoccurrenceof secondary studies reported inour sampleofonline reports is consistent
withpreviousfindingsshowingthatsystematicreviewsrepresentedasmallproportionofmedical
research news [29]. This trend is likely reflected in the frequency of these studies published in
journals, although we could not find any literature that directly investigated the publication
frequency of different study types in medical research. We found a majority of online news
articlesreportingonpeer-reviewedpapers,howeverthismaybepartlyexplainedbyourexclusion
of more general news articles that did not report on a specified study. Previous studies have
highlightedinconsistentqualityandaccuracyofsciencenewsreportingpracticesatmultiplelevels,
rangingfrominstitutionalpressreleasestonewspieces[16,17,21],andfoundthatstudytypes
withpoorermethodologygainmoremedia coverage than researchbasedon strongerevidence
[33-35].Ouranalysisofreportingqualityandstudytypedistributioninonlinenewsisconsistent
withpreviousevidenceofpoorqualityreportingbybroadsheetnewssources[19,20,23]anda
bias towardsprimary research [6,9, 46,47]. Thispredominanceofprimary studies in thenews
increases the likelihood that the general public is left with a distorted perception of cancer
researchandaninaccurateviewofscientificprogress[36].Thisispartlyduetotheincreasedrisk
ofprematurestatementsaboutyetun-replicatedresearchoutcomesandthegreaterlikelihoodof
consequent contradiction or refutation. For example, cancer drug attrition rates are
characteristically high, with only 5% of preclinical anticancer drugs reaching clinical use, and
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Amberg&Saunders–Biasincancerresearchreporting
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reproducibility of high-impact studies in this area is low [46]. Even therapies tested in phase II
clinicaltrialsrarelysucceedinreachingclinicalpractice[47].
Reportingqualityscoresvariedwithinandacrossthenewssources.Meanqualityscoresindicated
similaritybetweenTheGuardianandNYTimesbutweresignificantlylowerintheAustraliannews
sources.Pointingtoareasforpotentialfutureimprovement,SMHandABCoftenfailedtoconsult
anindependentexpert,providealinktothestudybeingdiscussed,maintainemphasis,andavoid
overgeneralisation.While all sources regularly failed to mention limitations of the study being
reported, Australian news more often omitted such statements. It should also be noted that
availabilityof resources indifferentmediaoutletsmayhavea significant influenceon reporting
qualitybutwewerenotabletomeasurethiseffect.Theonlinenewsmedia’sselectionofresearch
sourceshaspreviously beenevaluatedby testingwhetherAltmetric scores correlate to citation
indicesor journal impact factors,withconflicting results [48,49].Authorshaveargued that this
showsthatthebestresearcharticlesarenotnecessarilytheonesthatmakeittothenews.While
thismaybetrue,methodsbasedonAltmetricscoreswillnotcapturethequantityofnewsarticles
that discuss research without directly referencing a study. Furthermore, other studies have
indicatedthatalternativemetricsmaygenerateinconsistentresultsdependingondatacollection
methods[50],andthatcitationindexisnotnecessarilythebestmarkerofstudyquality[51,52].
Wedidnotobserveany relationshipbetweenquality and readership in reportsby theABC but
unfortunately couldnotexpand thisanalysisasaudiencedatawasnotavailable forothernews
outlets.Thelownumberofsecondarystudiesmadethecohortinthisstudyunderpoweredforan
analysiscomparingtypeandquality.
Previousanalysisof cancer research storieson theBBCwebsite from1998-2006 foundaheavy
focus on breast cancer, followed by lung and prostate cancers [53]. Almost a quarter of news
reports in our cohort did not refer to a specific cancer type, possibly reflecting the strong bias
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Amberg&Saunders–Biasincancerresearchreporting
20
towards reporting of basic research on disease mechanisms and risk. However, an important
underlyingfactorinthistrendmayalsobetheemergingtrendtodefinecancertypebymolecular
ratherthananatomicalclassifiers[54,55].Weobservedacorrelationbetweentherepresentation
of various cancer types (classified by anatomical site) and the relative incidence rates of those
cancertypes(Figure3b),butnorelationshipbetweenreportingfrequencyandrelativemortality
rates (Figure3c).Cervical,melanomaandbreast cancerwereover-represented relative to their
respectivemortality rates,while lung, pancreas, and colorectal cancerwereunder-represented.
Continued public and media interest on the effectiveness of the HPV vaccine Gardasil, and
changes in screening practices may be a relevant consideration in the over-representation of
reports focussing on cervical cancer. Over or under representation of different cancer types in
research reporting can skew public awareness of risk factors and may also drive inequities in
publicandphilanthropicfundingofresearchdirectedasspecificcancertypes.
Weobservedastrikingnationalbias,wherenewsoutletsweremorelikelytoreportonresearch
performedinthesamecountrytheywerebased.Ifthedistributionofstudiesreportedinallnews
outletsmirroredglobal researchoutput, thevastmajorityof reportswouldbebasedonstudies
performed in the US, as they dominate in terms of papers published [37]. However, a perfect
reflectionofglobaloutputisnotnecessarilydesirable.Itmaybedifficultforlocalscientiststoget
media attention outside their own country, and institutional press offices may have stronger
contact networkswith local reporters. Reporting research of relevance to distinct geographical
areas (e.g. epidemiological investigations on specific populations) may be very important in
informingthepublicwithregardstolocalriskfactorsandoutcomesofpubliclyfundedresearch.
Hence,thepredominanceofepidemiologicalstudiesinnewsreportsisonepossiblecontributorto
theobservednationalbias..Conversely,prioritisingreportingonlocalresearchmeansthepublic
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21
maynotgetaccesstoimportantinformationfrombroadersources,althoughthemodernonline
environmentputsglobalnewswithinreachofthemajorityofpeople.
TheMatilda effect, which describes the systematic under-recognition of female scientists, has
beenextendedtosciencecommunication,wheregreaterperceivedscientificqualityisassociated
with publications frommale authors [44, 45]. Further, under-representationofwomen in news
mediamoregenerallyiswellestablished[42,43].Weobservedastrikinggenderbiasinbothstudy
selection and reporting in our cohort,with themajority of reports based on studieswithmale
senior authors and quoting male experts. This bias has potential to compromise high-quality
coverageofresearchby limitingdiversityofopinion,and likelyservestoreinforcingstereotypes
and further entrench gender inequity among researchers by providing public visibility and
recognitionpredominantlytomalescientists.Thesuiteofbiasesfacedbyfemalescientistsiswell
documented [38-41], and the gender bias in news reports likely reflects an underlying
predominance ofmen among the ranks of senior scientists. The possibility of other underlying
biases can’t be excluded, including differences in the availability and/or willingness of male
expertstospeaktojournalists.Regardless,ourdatahighlightsaneedforjournalists,scientistsand
institutes to significantly improve efforts to ensure equal representation of male and female
scientistsinnewsreportsoncancerresearch.
Limitations
As cancer research output is not expected to fluctuate notably throughout the year, it was
assumedthatasix-monthsampleperiodlimitedto20reportsfromeachofthefournewsoutlets
would provide a representative cohort to analyse. An exception was conference-based news
reports,whichpeakedat the timeofamajorcancerconference in June (ASCOannualmeeting,
https://am.asco.org/).InallnewsoutletsapartfromTheGuardian,the20reportscomprisedthe
majority of relevant reports within the selected time frame and should thus be considered
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Amberg&Saunders–Biasincancerresearchreporting
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representative samples of each source. Although the size of our cohort limits a comprehensive
representationofnationalreportingtrends,thechosensourcesareallmajornewsoutletsintheir
respectivecountriesandso likelyprovidea reasonable indicationofbroader trends. Itwasalso
assumedthatallstudiescouldbeclassifiedaccordingtothemodeloutlinedbyRöhrigetal.[56].
Secondarystudiesweretooraretoallowanalysisofanypotentialrelationshipbetweenstudytype
andreportingquality,whichshouldbeinvestigatedinlargerdatasets.
Recommendationsandconclusions
Thequalityindicatorsmeasuredinourcohortprovideusefulguidelinesforjournaliststoconsider
in providing the most informative and accurate reporting of research. These are particularly
relevant tominimising the potential for hyperbole, providing an objective account of research
outcomes and implications, and in assisting readers to critically assess the report. For example,
reports in the Australian news outlets (SMH and ABC) often failed to consult an independent
expert, provide a link to the research study, and avoid overgeneralisation. While all sources
regularly failedtomention limitationsof thestudybeingdiscussed,Australiannewsmoreoften
omittedsuchstatements.Theselimitationsmayreflectlimitedtimeand/orresourcesofreporters
or a trend towards having fewer specialist reporters in Australianmedia, butwe are unable to
quantify these in our dataset.Our data highlight the importance of consideringwhich research
types are selected for coverage. Acknowledging the importance of journalists providing
independent and novel context, interpretation and insight to individual stories, a better
representationofthecurrentstateincancerresearchwouldbeachievedbyattemptingtocovera
more balanced proportion of primary and secondary studies, from national and international
sources.Scientistsandjournalistsshouldalsotakecaretomentionthelimitationsofnovelideasin
researchandrefrainfrompresentingfindingsascertain.
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Conversely, when communicating with the news media, scientists should be conscious of the
possiblediscrepancybetween impact inthescientificcommunityandamongthegeneralpublic.
Limitations and uncertainties should always be highlighted.Where possible, readers should be
made aware ofwhat type of study is being reported on,whether it is peer-reviewed and how
strong the supporting evidence is. These are important considerations, as even prestigious
newspapersdonotnecessarilygiveafairrepresentationofcurrentprogressincancerresearch.
Asfarasweknow,thisisthefirstcombinedanalysisofstudytypedistribution,reportingquality,
and other biases in cancer research reporting. These data highlight the presence of significant
biasesandprovideabasisforimprovingtheselectionofstudiesbeingselectedformediacoverage,
and theway those studies are reported. Future analyses should build on the findings reported
herebyincorporatingthelong-termoutcomesandimpactofthestudiesthatappearinthenews
media.Itwouldalsobeusefultoevaluatetowhatextentcorrectionsfollowinthenewsafterone
of thesestudieshavebeen refutedoradeclared ‘breakthroughdrug’ fails to reach themarket.
Further, analyses of relationships between readership, study type and reporting quality would
offerinsightintohowdemand-driventhesebiasesmaybe.
Accurate,contextualreportingofcancerresearch is imperative inhelpingthepublicunderstand
complexandchallengingscienceandappreciatetheoutcomesofpubliclyfundedresearch,avoid
underminingtrustinscience,andassistinformeddecision-making.
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Acknowledgements
TheauthorswishtothankDrAdamDunnandDrJonathonWebbforthoughtfulandconstructive
discussionandcommentsondraftmansucripts.
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25
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