Is Diagnosis Breast Cancer Nothing More than a Flip of a Coin?

The New York Times recently profiled a Michigan woman who endured a partial breast removal, weeks of radiation treatment, continuous drug therapy, and the intense psychological strain of a cancer diagnosis only to discover that she never actually had ductal carcinoma in situ (D.C.I.S.) cancer at all.

The woman went in for an annual mammogram at the small hospital where she worked. A biopsy followed and the results were sent to the head of the pathology department, who had not passed either part of the exam to become board certified until 2008, a year after he diagnosed the woman with cancer. She was given two options – a mastectomy or a quadrantectomy (removal of one-fourth of the breast), followed by six weeks of radiation. She opted for the quadrantectomy. A year later, she was told the pathologist made a mistake and she never had cancer. It had all been unnecessary — the surgery, the radiation, the drugs and, the emotional rollercoaster. The pathologist maintains that she had cancer and that two board-certified pathologists at a neighboring hospital concurred with his diagnosis.

Unfortunately, the Michigan woman’s ordeal is far from a rare occurrence. After both her breasts were removed, a Colorado woman was told that her initial pathology — which found an aggressive type of D.C.I.S. — was incorrect. Like the Michigan woman, she later moved and sought follow-up care at a larger facility. When the doctors requested her slides in order to help manage her care, she was shocked to learn they found no cancer. She later reached a settlement with the pathology group that had given her the misdiagnosis.

Cases like these may be extreme examples, but show why some doctors increasingly say that a woman’s initial reaction to a D.C.I.S. should be one of caution rather than a rush to disfiguring surgery or potentially harmful radiation. Diagnosing the earliest stage of breast cancer can be surprisingly difficult, prone to error and case-by-case disagreement over whether a cluster of cells is benign or malignant.

In 2006, Susan G. Komen, released a startling study. It estimated that in 90,000 cases, women who receive a diagnosis of D.C.I.S. or invasive breast cancer either did not have the disease or their pathologist made another error that resulted in incorrect treatment. After the Komen report, the College of American Pathologists announced several steps to improve breast cancer diagnosis, including the certification program for pathologists.

Today, D.C.I.S. is diagnosed in more than 50,000 women a year in the U.S. alone. 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. For many women the error of misdiagnosis of breast cancer is compounded by a tendency to commit to the most aggressive and irreversible treatment options, even though not necessary. These mistakes are harming thousands of women each year, many of whom never fully realize the extent of their doctors’ mistakes. The root problem is that we still don’t have a truly accurate diagnostic tool, and diagnosis can vary depending on one person’s reading of a tiny speck.

Mark Bello has thirty-three years experience as a trial lawyer and twelve years as an underwriter and situational analyst in the lawsuit funding industry. He is the owner and founder of Lawsuit Financial Corporation which helps provide legal finance cash flow solutions and consulting when necessities of life litigation funding is needed by plaintiffs involved in pending, personal injury litigation. Bello is a Justice Pac member of the American Association for Justice, Sustaining and Justice Pac member of the Michigan Association for Justice, Business Associate of the Florida, Tennessee, and Colorado Associations for Justice, a member of the American Bar Association as well as their ABA Advisory Committee, the State Bar of Michigan and the Injury Board