NCPA - National Center for Policy Analysis


July 21, 2010

Diagnosing the earliest stages of breast cancer is particularly difficult because advancements in mammography and other breast imaging technology have made it possible to see breast lesions "the size of a few grains of salt," the New York Times reports.  

  • Diagnosing Stage Zero or noninvasive cancer -- called ductal carcinoma in situ, or DCIS -- in past years was rare, but advances in mammography have led to more than 50,000 U.S. diagnoses annually.
  • If left untreated, noninvasive cancer cells can lead to cancer about 30 percent of the time, according to researchers. 

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 percent of 340 breast cancer cases had errors that were serious enough to require amended surgery plans. 

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 annually, among other requirements. 

Source: Stephanie Saul, "Earliest Steps to Find Breast Cancer Are Prone to Error," New York Times, July 19, 2010. 

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