Healthy Skepticism Library item: 19030
Warning: This library includes all items relevant to health product marketing that we are aware of regardless of quality. Often we do not agree with all or part of the contents.
Publication type: Journal Article
Welch HG, Woloshin S, Schwartz LM.
The sea of uncertainty surrounding ductal carcinoma in situ--the price of screening mammography.
J Natl Cancer Inst 2008 2 12; 100:(4):228-9
http://jnci.oxfordjournals.org/content/100/4/228.long
Abstract:
Wouldn’t it be easier if we lived in a binary world? Everything would be either black or white, yes or no, 1 or 0. And biopsy results would be either normal or cancer.
Unfortunately, in the world of cancer, our efforts to detect the disease early have made this a fantasy. We are increasingly faced with the reality of a big gray zone—a broad spectrum of pathologic findings between normal tissue and invasive cancer. And our nosology reflects the associated ambiguity—dysplasia, intraepithelial neoplasia, hyperplasia with atypia, and even abnormalities of “unknown significance.” The unifying theme for these findings is that they may progress to invasive cancer. Or they may not.
Despite the presence of the word “carcinoma,” ductal carcinoma in situ (DCIS) is the poster child for this problem (a senior pathologist involved in developing classification systems confided to one of us that he regretted the use of the term carcinoma in DCIS). No one believes that DCIS always progresses to invasive cancer, and no one believes it never does. Although no one is sure what the probability of progression is, studies of DCIS that were missed at biopsy (1,2) and the autopsy reservoir (3) suggest that the lifetime risk of progression must be considerably less than 50%. …
Keywords:
Autopsy
Biopsy
Breast Neoplasms/diagnosis*
Breast Neoplasms/epidemiology*
Breast Neoplasms/pathology
Carcinoma, Intraductal, Noninfiltrating/diagnosis*
Carcinoma, Intraductal, Noninfiltrating/epidemiology*
Carcinoma, Intraductal, Noninfiltrating/pathology
Female
Humans
Mammography*
Mass Screening
Palpation
Population Surveillance*
Risk Assessment
Risk Factors
Uncertainty
