Early-Stage Breast Cancer Diagnosis More Prone To Errors

Main Category: Breast Cancer
Article Date: 21 Jul 2010 - 3:00 PDT

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Diagnosing the earliest stages of breast cancer is a particularly challenging area of pathology, as advancements in mammography and other breast imaging technology can show images "the size of a few grains of salt," the New York Times reports. Diagnosing ductal carcinoma in situ -- also known as Stage 0 or noninvasive cancer -- used to be rare, but advances in mammography have led to more than 50,000 U.S. diagnoses per year. Researchers say that if left untreated, DCIS cells can lead to cancer about 30% of the time.

However, a Times examination of breast cancer cases found that DCIS diagnosis can be "prone to both outright error and case-by-case disagreement" among doctors and pathologists. Incorrect diagnoses of DCIS can lead to unnecessary treatment and undue psychological stress for the patient. According to the Times, there are no mandated diagnostic standards or requirements for pathologists conducting the tests.

Shahla Masood, head of pathology at the University of Florida's College of Medicine, said that DCIS diagnosis "is a 30-year history of confusion, differences of opinion and under- and overtreatment." She added, "There are studies that show diagnosing these borderline breast lesions occasionally comes down to the flip of a coin."

One such study -- conducted in 2006 by the Susan G. Komen For the Cure -- found that an estimated 90,000 DCIS cases were misdiagnosed or the pathologist made an error that led to incorrect treatment. A 2002 study by doctors at Northwestern University Medical Center found that 7.8% of 340 breast cancer cases had errors that were serious enough to require amended surgery plans.

The issues related to DCIS diagnosis "take on added significance when combined" with criticism about overtreating and overdiagnosing the cancer type in the U.S., the Times reports. Most recently, guidelines issued by the U.S. Preventive Services Task Force -- recommending that most women start annual mammogram screening at 50 instead of 40 -- became the focus of controversy. In the decision, members of the panel referred to overdiagnosis of DCIS and benign but atypical breast lesions that would not cause problems if left undetected, noting that women diagnosed with such lesions may not benefit from early detection.

In an effort to address the issue, the federal government is funding a national study of variations in breast pathology. In addition, the College of American Pathologists said it will start a voluntary certification program that requires pathologists who read breast tissue to handle 250 breast cases per year, among other requirements (Saul, New York Times, 7/20).

U.S. Women Fall Behind in Breast Cancer Screening, CDC Report Says

In related news, one-fifth of U.S. women ages 50 to 74 have not kept up with regular mammograms, with uninsured women being the least likely to undergo screening, according to a report in the Centers for Disease Control and Prevention's Morbidity and Mortality Weekly Report, the Times reports. The percentage of women ages 50 to 74 who receive breast cancer screenings every two years increased steadily in the 1990s, but the rate has remained stagnant at just over 80% since 2000, according to the report.

For the report, CDC examined data collected from 120,095 surveys. The report also found that mammography rates varied by region, with the highest rates occurring in the Northeast. The West-Central states, which have lower populations and fewer mammography clinics, showed the lowest rates.

Seventy percent of Native American women said they had been screened recently, and black women were as likely as white women to have had recent screenings at just over 80%. Marcus Plescia, director of CDC's division of cancer prevention and control and lead author of the report, said that the increase in screening among black women is "good news," adding that CDC "want[s] to get the rates up even higher." He added that CDC is "optimistic" that preventive care provisions in the new federal health care reform law (PL 111-148) "ought to make a difference" (Caryn Rabin, New York Times, 7/20).

Reprinted with kind permission from http://www.nationalpartnership.org. You can view the entire Daily Women's Health Policy Report, search the archives, or sign up for email delivery here. The Daily Women's Health Policy Report is a free service of the National Partnership for Women & Families.

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