What Is True/Slant?
275+ knowledgeable contributors.
Reporting and insight on news of the moment.
Follow them and join the news conversation.
 

Jul. 20 2010 - 5:28 pm | 72 views | 0 recommendations | 0 comments

Early cancer tests, surgeries questioned

Was this mastectomy necessary? It’s a question few breast cancer survivors want to ask, and one that few are likely to answer absolutely. But after years of aggressive emphasis on early diagnosis and treatment, some previous imperatives are being called into question. Noting that breast biopsy has long been considered the “gold standard,” a report in today’s New York Times addresses the new rethinking:

As it turns out, diagnosing the earliest stage of breast cancer can be surprisingly difficult, prone to both outright error and case-by-case disagreement over whether a cluster of cells is benign or malignant, according to an examination of breast cancer cases by The New York Times.

Advances in mammography and other imaging technology over the past 30 years have meant that pathologists must render opinions on ever smaller breast lesions, some the size of a few grains of salt. Discerning the difference between some benign lesions and early stage breast cancer is a particularly challenging area of pathology, according to medical records and interviews with doctors and patients.

Diagnosing D.C.I.S. “is a 30-year history of confusion, differences of opinion and under- and overtreatment,” said Dr. Shahla Masood, the head of pathology at the University of Florida College of Medicine in Jacksonville. “There are studies that show that diagnosing these borderline breast lesions occasionally comes down to the flip of a coin.”

Much of the current finger-pointing is toward pathologists, where their money comes from, whether they are ‘certified’ or not and in general, how good a job they do.

In 2006, Susan G. Komen for the Cure, an influential breast cancer survivors’ organization, released a startling study. It estimated that in 90,000 cases, women who receive a diagnosis of D.C.I.S. or invasive breast cancer either did not have the disease or their pathologist made another error that resulted in incorrect treatment.

After the Komen report, the College of American Pathologists announced several steps to improve breast cancer diagnosis, including the certification program for pathologists.

For the medical community, the Komen findings were not surprising, since the risk of misdiagnosis had been widely written about in medical literature. One study in 2002, by doctors at Northwestern University Medical Center, reviewed the pathology in 340 breast cancer cases and found that 7.8 percent of them had errors serious enough to change plans for surgery.

This space has argued occasionally for reconsideration of yearly mammograms and for longer, stronger consideration of other options before a mastectomy is performed. Especially in the case of older women.

Would I insist on further studies or opt for less radical treatment if I were diagnosed with breast cancer today? Probably. Can I undo the mastectomy I had at 72? Not exactly. Second-guessing is beside the point for someone who is healthy and fit, but asking questions won’t ever hurt.

Earliest Steps to Find Breast Cancer Are Prone to Error – NYTimes.com.


Comments

No Comments Yet
Post your comment »
 
Log in for notification options
Comments RSS
 

Post Your Comment

You must be logged in to post a comment

Log in with your True/Slant account.

Previously logged in with Facebook?

Create an account to join True/Slant now.

Facebook users:
Create T/S account with Facebook
 

My T/S Activity Feed

 
     

    About Me

    I’ve been a writer since probably before you were born: newspapers, magazines, trade publications and websites beginning with Beliefnet.com’s start-up issue. Working as a hospice volunteer and with AIDS groups led to a 1999 book Dying Unafraid (still in print and apropos) and more involvement with end-of-life causes. This is how to end any cocktail party conversation: “I write a lot about end-of-life issues.” So with Boomers and Beyond I’m working backwards and sideways and wherever concerns of these generations lead. I grew up in beautiful downtown Ashland, VA) and migrated through Atlanta eventually to San Francisco where I live with my final husband, Bud (my college Senior Dinner Dance date before we lost track of each other for 37 years.) Manhattan/Asheville/Atlanta kids, parents of my five flawless grandchildren, keep me attuned to Boomerhood. Full rather braggadocio disclosure: the Manhattan daughter Sandy is married to T/S super-contributor Miles O’Brien.

    See my profile »
    Followers: 88
    Contributor Since: May 2009