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Early Breast Cancer Diagnosis Could Be Wrong

By Edward C. Geehr, M.D.,

An early cancer diagnosis often means an improved outcome. But not always. Every year, approximately 50,000 women are diagnosed with ductal carcinoma in situ (DCIS) of the breast. Often called non-invasive or Stage 0 breast cancer, DCIS responds well to treatment. Unfortunately, approximately 20% of cases may be misdiagnosed.

In DCIS, abnormal cells are contained in the lining of the milk ducts. In situ, which means “in place,” the cancer cells haven’t left the ducts to invade nearby breast tissue. Although DCIS is considered to be non-invasive, if left untreated, about 20%-30% of women will progress to invasive cancer.

Experts believe misdiagnosis happens because doctors disagree over which criteria they use. For example, some pathologists hold that lesions less than 2 millimeters preclude the diagnosis regardless of cell appearance, while others rely on the presence of characteristic changes regardless of lesion size.

But even appearance can lead to disagreement. One expert reviewed approximately 600 breast cases and found discrepancies in 141 of them, including 27 cases where DCIS was misdiagnosed. DCIS is typically diagnosed from microscopic core needle biopsies. It can be difficult to distinguish between low-grade DCIS and benign conditions, such as atypical ductal hyperplasia which can be misread as much as 20% of the time.

Another factor may be that many breast biopsies each year are performed in community hospitals where pathologists have limited exposure to DCIS or unusual breast cancer tumors. This has led the College of American Pathologists to call for a voluntary certification program for pathologists who read breast tissue. They’ve proposed a minimum requirement of 250 breast cases a year to be certified.

The potential for misdiagnosis and overtreatment of DCIS was recently disputed in a discussion about the age to begin mammography. Before the widespread use of mammography in the 1980s, DCIS was rarely diagnosed. Until that time, most biopsies were performed after feeling lumps in the breast. By then, most lesions were usually well established as cancer, benign tumor, or cyst.

As noted, in a percentage of cases untreated, DCIS will progress to invasive cancer. And even though DCIS is 90% curable, many experts are concerned that patients and their doctors may decide on more aggressive therapy than is necessary, such as a combination of mastectomy, radiation, and drug therapy. In fact, the rate of double mastectomy for DCIS rose to 5% in 2005 from 2% in 1998.

So the benefits of earlier diagnosis are offset by potential misdiagnosis and over-treatment.


Man Robs Bank In Order To Get Health Care

By Zachary Roth

Some people who need medical care but can’t afford it go to the emergency room. Others just hope they’ll get better. James Richard Verone robbed a bank.

Earlier this month, Verone (pictured), a 59-year-old convenience store clerk, walked into a Gaston, N.C., bank and handed the cashier a note demanding $1 and medical attention. Then he waited calmly for police to show up.

He’s now in jail and has an appointment with a doctor this week.

Verone’s problems started when he lost the job he’d held for 17 years as a Coca Cola deliveryman, amid the economic downturn. He found new work driving a truck, but it didn’t last. Eventually, he took a part-time position at the convenience store.

But Verone’s body wasn’t up to it. The bending and lifting made his back ache. He had problems with his left foot, making him limp. He also suffered from carpal tunnel syndrome and arthritis.

Then he noticed a protrusion on his chest. “The pain was beyond the tolerance that I could accept,” Verone told the Gaston Gazette. “I kind of hit a brick wall with everything.”

Verone knew he needed help–and he didn’t want to be a burden on his sister and brothers. He applied for food stamps, but they weren’t enough either.

So he hatched a plan. On June 9, he woke up, showered, ironed his shirt. He mailed a letter to the Gazette, listing the return address as the Gaston County Jail.

“When you receive this a bank robbery will have been committed by me,” Verone wrote in the letter. “This robbery is being committed by me for one dollar. I am of sound mind but not so much sound body.”

Then Verone hailed a cab to take him to the RBC Bank. Inside, he handed the teller his $1 robbery demand.

“I didn’t have any fears,” said Verone. “I told the teller that I would sit over here and wait for police.”

The teller was so frightened that she had to be taken to the hospital to be checked out. Verone, meanwhile, was taken to jail, just as he’d planned it.

Because he only asked for $1, Verone was charged with larceny, not bank robbery. But he said that if his punishment isn’t severe enough, he plans to tell the judge that he’ll do it again. His $100,000 bond has been reduced to $2,000, but he says he doesn’t plan to pay it.

In jail, Verone said he skips dinner to avoid too much contact with the other inmates. He’s already seen some nurses and is scheduled to see a doctor on Friday. He said he’s hoping to receive back and foot surgery, and get the protrusion on his chest treated. Then he plans to spend a few years in jail, before getting out in time to collect Social Security and move to the beach.

Verone also presented the view that if the United States had a health-care system which offered people more government support, he wouldn’t have had to make the choice he did.

“If you don’t have your health you don’t have anything,” Verone said.

The Affordable Care Act, President Obama’s health-care overhaul passed by Congress last year, was designed to make it easier for Americans in situations like Verone’s to get health insurance. But most of its provisions don’t go into effect until 2014.

As it is, Verone said he thinks he chose the best of a bunch of bad options. “I picked jail.”

(Photo: Ben Goff/The Gaston Gazette)


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