Stop the Press!

Last month, JAMA published a paper that created waves. The study – “Diagnostic concordance among pathologists interpreting breast biopsy specimens,”(1) – cites its primary objective as quantifying “the magnitude of diagnostic disagreement among pathologists compared with a consensus panel.” If you get the sneaking suspicion that the outcome was unlikely to be positive, you’re not wrong; disagreement was reported in around 25 percent of cases.Unsurprisingly, discordance was highest in those cases deemed as “borderline” diagnoses of atypical hyperplasia and DCIS. Though the results are pretty damning on the face of it, the lack of commonality between the study methodology and real-life conditions was not given sufficient attention. For example, the pathologists who took part were unable to solicit a second opinion; not only is that commonly practiced, it’s expected.

Nonetheless, the story was inevitably spread via many media channels in the medical profession and beyond. Even more worryingly, there have also been reports on the dwindling number of women attending breast cancer screening in some countries; better education on the risk of misdiagnosis being cited as a factor. It is clear that pathology is gaining a bad reputation from some of this publicity – unjustifiably. We talk regularly of the need for pathologists to communicate with those outside of their profession and to educate on the value of pathology. Sadly, most consumer attention tends to be generated when things apparently “go wrong”. The press will always pick up on the most impactful and newsworthy element of a piece of research. And let‘s face it, pathologists disagreeing on diagnoses is a pretty shocking and saleable story. But perhaps this situation can be flipped on its head and used to pathologists’ advantage. Why not get out there and talk about your role, in particular its criticality to a patient’s health, and defend against some of the research that has negatively represented pathology to the public and your medical peers? In response to the JAMA piece, we did our own digging around and bring you the story from different perspectives in this month’s cover feature. Don’t let negative comments go unanswered on Twitter, Facebook or LinkedIn - better still, write a blog about the bias introduced by reporters and link to as many sources as possible. In other words: take control.

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