Docs quick to dismiss breast cancer without biopsy

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Docs quick to dismiss breast cancer without biopsy

Last Updated: 2002-06-24 10:00:32 -0400 (Reuters Health)

NEW YORK (Reuters Health) - Too many breast cancer patients are

initially told they are cancer-free, most often because their physicians

said they believed the suspicious mass was harmless and didn't perform a

biopsy to check, according to researchers.

" Despite widespread screening mammography, inappropriate reassurance

that a palpable mass is benign, without biopsy, remains the leading

cause of physician-delayed diagnosis of breast cancer, affecting 5% of

patients in our series, " Dr. H. Goodson of the the California

Pacific Medical Research Institute in San Francisco, and his co-author

Dr. Dan H. write.

" Combining all causes, 9% of patients experienced delay, " Goodson and

added.

Although most patients with breast cancer do not experience a delay in

diagnosis, previous studies have found that between 6% and 16% of

patients are initially, and mistakenly, told by their doctors that they

do not have the disease. If 180,000 women develop breast cancer each

year, the authors reason, at least 10,000 patients may be initially

misdiagnosed as cancer-free.

Goodson and set out to determine the most common causes of delay

in physicians' ability to diagnose breast cancer by examining the time

taken to correctly diagnose 435 patients who underwent surgery to remove

454 breast cancers.

Goodson and found that a total of 42 cancers, or 9% of all

diagnosed, belonged to patients who were initially told they were

cancer-free. Half of the delays in diagnosis lasted 9 months or longer,

and the longest delay lasted 3 years.

Most of the patients given an initially incorrect diagnosis were told by

their doctors that a suspicious lump was benign without performing a

biopsy, during which doctors remove cells from the lump to test for the

presence of disease. Another 14 patients did not receive a prompt

diagnosis because their mammograms had been misread, and 9 others were

mistakenly diagnosed as cancer-free because of botched biopsies, either

a misreading of the results or from mistakes in performing the

procedure.

One aspect that might influence delays in diagnosis, the authors report,

is whether or not patients found the suspicious mass themselves or the

lump was detected by a woman's doctor. Although 35% of cancers in this

study group were first discovered by the patient herself, patient-found

tumors represented almost two-thirds of all cases in which a delay in

diagnosis occurred.

" Physicians seem to intuit lower cancer risk for self-discovered masses

and seek to reassure patients using CBE (clinical breast examination) or

mammography, without performing biopsy, " Goodman and write in the

June 24 Archives of Internal Medicine.

In order to reduce the risk of delays in diagnosis, the authors

recommend that doctors not rely on clinical breast exams to indicate

whether a suspicious lump is cancerous. Furthermore, Goodman and

write that biopsies should be conducted by trained professionals, who

are less prone to mistakes.

" Reducing delay in diagnosis will require less willingness to rely on

clinical examination to decide that a mass is benign, less reliance on

benign mammography reports to decide not to biopsy a mass, and a

requirement that fine-needle aspiration biopsy be done by persons with

demonstrated competence for the procedure, " Goodman and conclude.

SOURCE: Archives of Internal Medicine 2002;164:1343-1348.