The Dog’s Blog: The challenge of communicating risk
The challenge of communicating risk
Not many patients return their medicines to the pharmacy, saying they don’t want to take them. Yet it seems to happen quite a lot with Vagifem (oestrogen tablets for vaginal administration). Often the reason given is that the woman doesn’t want to use any form of HRT, because of a worry about the risk of breast cancer. It’s true that Vagimen contains oestrogen, which is in HRT products (either on its own or with a progestogen). But there are important differences between it and conventional HRT products (which are mainly used in the form of tablets or patches). Vagifem is a form of HRT but the dose of oestrogen absorbed is very low.
The risk of breast cancer associated with HRT has been in the news recently following publication of a new data analysis. The main message communicated in the headlines was that using HRT does increase the risk of breast cancer and that some risk remains for a few years after stopping treatment. But what was missing was a lot of important detail about the different forms of HRT and a context – how the risk relates to the benefits of the treatment and to other risks in life.
Informing people about risks is not easy because drawing attention to them can cause fright. Baldly announcing risk can itself lead to harm. For example, in the past news about the higher risk of thrombosis associated with certain types of contraceptive pill led to women stopping their pills abruptly, so increasing the risk of pregnancy, which itself carries a much higher risk of thrombosis than the contraceptive pill (along with all the other consequences of a pregnancy).
What the recent news headlines about HRT did not report is that no increased risk of breast cancer has been found with low-dose vaginal oestrogen or from using systemic HRT for less than a year. Putting the risk of HRT into context also means knowing that the risk of breast cancer from HRT is less than that associated with regularly drinking alcohol or being obese. There’s also the important aspect of the benefit of the treatment and whether the woman considers that it outweighs the risks. Clearly it’s crucial that women get accurate and balanced information about the risks and benefits of treatment from healthcare professionals when discussing treatment options.
Why this has got anything to do with animals is that it is just as important for people to know the facts about the risks and benefits of treatments recommended for their pets. Preconceived opinions about the dangers of NSAIDs abound among pet owners. So veterinary professionals have a crucial role to play in providing pet owners with a clear explanation about the likelihood of adverse effects in the context of the benefits, helping owners to recognise the effects, and explaining how monitoring will help prevent serious but rare side effects. There is also nothing wrong with being honest about what the uncertainties are, because of gaps in the evidence.
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