“Breast Biopsies Leave Room for Doubt, Study Finds,” Denise Grady, The New York Times.

New findings reported in JAMA challenge the common belief that a biopsy is the gold standard and will resolve any questions that might arise from an unclear mammogram or ultrasound.

In the United States, about 1.6 million women a year have breast biopsies; about 20 percent of the tests find cancer. Ten percent identify atypia, a finding that cells inside breast ducts are abnormal but not cancerous. About 60,000 women each year are found to have ductal carcinoma in situ (DCIS), which also refers to abnormal cells that are confined inside the milk ducts and so are not considered invasive; experts disagree about whether DCIS is cancer.

An editorial in JAMA called the findings “disconcerting.” It said the study should be a call to action for pathologists and breast cancer scientists to improve the accuracy of biopsy readings, by consulting with one another more often on challenging cases and by creating clearer definitions for various abnormalities so that diagnoses will be more consistent and precise. The editorial also recommended second opinions in ambiguous cases.

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The Study: Elmore JG, Longton GM, Carney PA, et al. Diagnostic Concordance Among Pathologists Interpreting Breast Biopsy Specimens. JAMA. 2015;313(11):1122-1132. doi:10.1001/jama.2015.1405.


Related:

  • Carcinoma: What’s In A Name? by Gayle Sulik on Psychology Today.
  • Overdiagnosis and Overtreatment in Cancer: An Opportunity for Improvement, by Laura J. Esserman, MD, MBA; Ian M. Thompson Jr, MD; Brian Reid, MD, PhD, JAMA, 2013 ; 310(8):797-798.
  • Allegra CJ, Aberle DR, Ganschow P, Hahn SM, Lee CN, Millon-Underwood S, Pike MC, Reed SD, Saftlas AF, Scarvalone SA, Schwartz AM, Slomski C, Yothers G, Zon R. National Institutes of Health State-of-the-Science Conference Statement: Diagnosis and Management of Ductal Carcinoma In Situ September 22–24, 2009. J Natl Cancer Inst. 2010; 102(3):161–169. (Download PDF)
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