Questions about Early Breast Cancer Diagnosis
Diagnosing breast cancer in its earliest stages can sometimes be very wrong, according to an examination of breast cancer cases by The New York Times.
The newspaper says it can be "surprisingly difficult, prone to both outright error and case-by-case disagreement" over whether or not cells are malignant.
On "The Early Show," CBS News Medical Correspondent Dr. Jennifer Ashton pointed out that, "When you talk about breast cancer, it's really like saying you're talking about the weather. There are so many different types of breast cancer.
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"This particular article really dealt with a type known as DCIS, or ductal carcinoma in situ, the most common type of noninvasive breast cancer. It's also referred to as stage zero breast cancer, diagnosed about 50,000 cases per year."
Ashton noted that DCIS is 90 percent curable, but, "This article raises concerns that, more than 17 percent of the time, it might be misdiagnosed, saying there's a cancer there when, in fact, there is not."
Reasons DCIS could be prone to misdiagnosis, she said, fall into three basic categories. "One is based on imaging. When you're talking about breast cancer, when you're talking about mammography, it's not a perfect imaging modality, particularly in young women. It can see things there that are not cancer and it can miss cancers that are there.
"Further, when you go on and talk about DCIS, we're talking also about mistakes in the biopsy process. This is when part of the tissue is removed, a pathologist looks at that slide and has to make the call. Is this or is this not cancer? And when you're talking about diagnosing a cancer at an early stage, that is fraught with human error.
"And finally … mistakes with treatment. There is controversy amongst medical oncologists and breast cancer surgeons about how this cancer should be treated and, in some cases, even if it should be treated, because it doesn't always progress to invasive cancer."
That, Ashton continued, is because such treatments "are not low risk or low morbidity; we're talking about invasive and potentially disfiguring treatments, surgeries, and also the psychological impact and fear and stress on a woman, which is not insignificant."
And what should a woman do if she's diagnosed with DCIS?
"Number one," Ashton stressed, "get a second opinion, and in some cases get a third opinion. When you're talking about a cancer diagnosis, you might want to have that slide reviewed by another pathologist. Do not feel like you need to rush to treatment. You have time to consider these options. And lastly, as we say with so many things, consider the risks versus the benefits versus the options to any proposed treatment."