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“Stage Zero” Breast Cancer Diagnoses on the Rise

Traditionally, cancers have been diagnosed in stages ranging from one to four, with four being reserved for the most serious, usually terminal, cases. In recent years, however, some physicians have created a de facto fifth stage - stage zero - when discussing breast cancer. The controversial stage zero diagnosis given to a relatively common and nearly always treatable condition, ductal carcinoma in situ (DCIS), has patients reeling from what they assume is a diagnosis of breast cancer and has some doctors seeing red at the possibly unnecessary surgeries and therapies that come along with it.

What is DCIS?

DCIS is a condition in which abnormal - but not necessarily cancerous - cells are seen lodged in a breast's milk ducts. The cells are said to be "in situ," meaning that they are trapped in one location and have not yet spread to other tissues. It is possible, however, to have several separate and distinct occurrences of DCIS in a single breast. The condition is highly treatable (around 90 percent of cases are curable), rarely fatal and, when left untreated, only develops into an invasive cancer about 30 percent of the time.

Controversy has surrounded the DCIS diagnosis for years, leading to as many as 17 percent of women being over-treated, undergoing aggressive surgeries (even double mastectomies), radiation regimens and experimental drug therapies in an attempt to stave off a future stage four cancer. Not only are women being misdiagnosed with DCIS when they do not have cancer, malignant tissue is being missed in screening exams.

How is DCIS Diagnosed?

Currently DCIS is found in the same way as most other current breast cancers - through mammography. The relative ease and availability of mammograms mean that more and more women are being alerted to the presence of microscopic amounts of abnormal tissue very early on. Early detection, an invaluable tool against malignant cancers, can be a Catch-22 for benign diagnoses like DCIS and a similar condition, atypical ductal hyperplasia (ADH). The small size of tissue samples obtained through needle biopsy - the most common and least-invasive internal diagnostic method - means that there is room for interpretation of nearly every test result. Renowned California pathologist Dr. Michael Lagios estimates that as many as 20 percent of biopsies of DCIS and ADH are misread and thus misdiagnosed.

Is Anything Being Done to Prevent Future Misdiagnoses?

Oncologists around the country, buoyed by findings in a recent study by the Susan G. Komen for the Cure foundation, are supporting a certification program for pathologists who will be responsible for making diagnoses of DCIS, ADH or other conditions based upon mammograms, biopsies and other tests. The certification program, still in its infancy, would ensure that only the most skilled physicians would be responsible for these life-changing diagnostic decisions by making sure that pathologists have the experience necessary to correctly interpret even the most difficult test results.

Until such a time when only properly trained and certified pathologists are responsible for diagnosing DCIS and other cancers, misdiagnosis will occur. If you or a loved one has been misdiagnosed, undiagnosed or overly treated for DCIS or another medical condition, consult an experienced medical malpractice attorney in your area to learn more about your legal rights and options.

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