The earliest stage of breast cancer is called ductal carcinoma in situ, or D.C.I.S. Pathologists in the United States conduct hundreds of thousands of breast biopsies every year and mammography technology has advanced in the past 30 years. However, D.C.I.S. is difficult to diagnose and studies have shown that many pathologists have given incorrect diagnoses.
In 2006, the Susan G. Komen for the Cure organization released a study which estimated that 90,000 women that received a diagnosis of D.C.I.S. or invasive breast cancer did not have the disease or received incorrect treatment.
In 2002, a study by doctors at Northwestern University Medical Center reviewed 340 cases of breast cancer and D.C.I.S. and found 7.8% of the cases had diagnostic errors significant enough to alter treatment plans.
D.C.I.S. Is Often Over-Treated
Since the 1980’s, mammograms have become more common and women over age 40 have, until recently, been recommended to have a mammogram every year. Many consider D.C.I.S. as over-diagnosed and over-treated, sometimes with unnecessary surgeries and harmful radiation. D.C.I.S. is diagnosed in more than 50,000 women each year in the U.S.
When diagnosing breast cancer, a pathologist takes a thin sample of breast tissue and inspects the cells for signs of cancer under a microscope. D.C.I.S. lesions can sometimes be as small as a few grains of salt.
Detection of early stage breast cancer has been called a “gray zone” and can be easily confused with benign lesions. Many general pathologists with small practices don’t have the experience or exposure needed to properly diagnose the disease.
The College of American Pathologists has announced their plans to offer a voluntary certification program in breast pathology. Upon completion of the program, a certified pathologist must read a minimum of 250 breast cases a year.
The rate of double mastectomy in women who had surgery for D.C.I.S. rose to 5% in 2005 from 2% in 1998. D.C.I.S. is 90% curable and mastectomies are usually not necessary unless it is large or occurs in multiple places.
Women that receive a diagnosis of D.C.I.S. are cautioned not to make any immediate plans for surgery or chemotherapy. Getting second opinions from large hospitals with experienced pathologists is strongly recommended.
Related Resouce: NY Times “Prone to Error: Earliest Steps to Find Cancer”