Today’s New York Times has an excellent article about the challenges of diagnosing breast cancer in its early stages.

The article focuses on issues related to a type of breast cancer (Ductal Carcinoma In Situ, or DCIS), but it also raises a couple of really important issues of which every patient should be aware:

  • Misdiagnoses occur relatively frequently:
    • The article mentions a 2002 study involving the review of 340 breast cancer cases where “7.8 percent of them had errors serious enough to change plans for surgery“. (emphasis added)
    • The article also cites a 2007-2008 study involving the review of 597 breast cancer cases where “discrepancies” were found in 141 cases (23.6%) and 27 cases (4.5%) were misdiagnosed altogether. (emphasis added)

  • Proper training and experience are key to good health outcomes:
    • The pathologist involved in a misdiagnosed case was not “Board Certified” in his specialty, meaning that he had not passed the rigorous certification exam required to demonstrate competency in his field.  A number of studies (here and here) have shown that board certified doctors provide higher quality care.
    • The pathologist mentioned above also saw a very small volume of breast cancer cases per year (only about 50), which is far below the College of American Pathologists minimum of 250 cases per year required for its new voluntary certification program. Research (here and here) has shown a clear relationship between higher case volumes and better patient outcomes.

As our health care system evolves we’re likely to see more pressure on doctors to see more patients, less time spent on any particular patient’s case, and more patients being misdiagnosed.  As more than 30 million new patients move into the health care system there will likely be a shortage of highly trained physicians, requiring less well trained physicians and other allied health professionals (Nurse Practitioners and Physician’s Assistants) to fill the void.

You can protect yourself against bad health outcomes by:

  • Seeking care from physicians who have demonstrated that they have passed the board certification in their specialty(s).  A number of websites (here and here) allow you to check your doctor’s status.
  • Seeking care from physicians and at institutions where they have a great deal of experience dealing with your specific condition.  As a rule of thumb you should seek out providers and institutions that take care of patients like you every day.
  • Finally, you should always ask for a second opinion if you are diagnosed with a condition that will require a major operation or intensive medical therapy.  You should also seek out a second opinion if you can’t get a definitive diagnosis for your condition.