Recent media attention on diagnostic discordance has patients shying away from cancer screening – but are they justified?
Michael Schubert |
The messages are everywhere around us – campaigns for breast cancer screening, for prostate cancer testing, for gynecological exams, for colonoscopies. Patients are warned to stay ahead of the potential risks by making sure they have regular checks. Though there’s plenty of dissent in the medical community about cancer screening – who should get it, when it should be done, which methods are most reliable – it’s hard to deny that early testing can save lives. But how reliable is this screening, and how much does success depend on the pathologist behind the test?
A recent report in JAMA has drawn a lot of attention for its investigation of diagnostic concordance between pathologists interpreting breast biopsy specimens (1). The authors of the paper attempted to quantify the degree of disagreement between diagnoses provided by different pathologists for the same specimens. To do so, they generated a set of 240 excisional or core needle breast biopsy specimens randomly selected from pathology registries affiliated with the Breast Cancer Surveillance Consortium. From each biopsy, new slides were prepared in a single laboratory for consistency, and the best of those slides was selected by consensus panel for inclusion in the set of test cases. Specimens exhibiting atypia and ductal carcinoma in situ (DCIS) were oversampled, as were cases from women either in the 40-49 age category or with mammographically dense breast tissue. These types of samples were emphasized because age and breast density are key risk factors for both benign breast disease and cancer, and because atypia and DCIS are often more difficult to diagnose or appear “borderline” between multiple diagnostic categories – so the researchers predicted that there would be more discordance between different pathologists’ conclusions.
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