New scru­tiny of breast can­cer mis­di­ag­noses

Austin American-Statesman - - WORLD & NATION -

Di­ag­nos­ing the ear­li­est stage of breast can­cer can be sur­pris­ingly dif­fi­cult, prone to both out­right er­ror and caseby-case dis­agree­ment about whether a clus­ter of cells is be­nign or ma­lig­nant, ac­cord­ing to a New York Times ex­am­i­na­tion of breast can­cer cases.

Ad­vances in mam­mog­ra­phy and other imag­ing technology dur­ing the past 30 years have meant that pathol­o­gists must ren­der opin­ions on ev­ers­maller 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 what is known as duc­tal car­ci­noma in situ “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.”

There is an in­creas­ing recog­ni­tion of the prob­lems, and the fed­eral govern­ment is now fi­nanc­ing a na­tion­wide study of vari­a­tions in breast pathol­ogy, based on con­cerns that 17 per­cent of the duc­tal car­ci­noma cases iden­ti­fied by a com­monly used nee­dle biopsy may be mis­di­ag­nosed. De­spite this, there are no man­dated di­ag­nos­tic stan­dards or re­quire­ments that pathol­o­gists per­form­ing the work have any spe­cial­ized ex­per­tise, mean­ing that the chances of get­ting an ac­cu­rate di­ag­no­sis vary from hos­pi­tal to hos­pi­tal.

Duc­tal car­ci­noma in situ is di­ag­nosed in more than 50,000 women a year in this coun­try alone. The ab­nor­mal cells, which are en­cased in breast ducts, are re­moved be­fore they de­velop into in­va­sive can­cer.

There are es­ti­mates that if left un­treated, the con­di­tion will turn into in­va­sive can­cer 30 per­cent of the time, though it could take decades in some cases.

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