Biopsies are supposed to be the definitive insights into whether or not breast cancer exist (but are they really?). Pathologists tend to err on the side of cancer without clear margins. Why? A fear of liability. The doctor would rather err on the side of saying it’s cancer rather than to say it’s not cancer (because being incorrect on the non-cancer side is coverage for the Doctor’s liability). In some ways, the Doctor is taking out a liability policy, but at the same time, putting some patients through an unnecessary grief phase.
The fear of being charged malpractice looms large for doctors in the area of breast cancer. Not so good for patients who have to go through surgery, radiation and chemo for an equivocal diagnosis. There is really know incentive to being wrong about the existence of a non-cancerous abnormality, they just don’t want to be wrong about the existence of actual breast cancer: It’s a game, and patients are continually losing it.
The Herald Tribune published an article last week titled Biopsy Doesn’t Always Give Clear Answer. You can read it in full here. Here are a couple of red flags to note (though I encourage you to read this article, as well as do more research for yourself).
“It is often thought that getting the biopsy will give definitive answers, but our study says maybe it won’t,” said first author Joann G. Elmore, a professor at the University of Washington School of Medicine.
An editorial in JAMA said the findings were “disconcerting”and that 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. The editorial also recommended second opinions in ambiguous cases.
This is all but an admission that the biopsy undertaking is a rather vague approach to what is clearly one of the most important moments for women (and men). To have that reliance be on “disconcerting” procedures is rather scary.
It might be difficult to blame Doctors for their imposition, we do live in a litigious society which puts incentive in “just not being wrong.” It would however be nice to see change happen in this area. But that change will only start with the patients, never the Doctors. So educate yourselves to the best of your ability about the matter.
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