..and if I remember much from histology, it often comes in shades of pink.

The NYT today has an interesting article; shock horror  – cancer that might not be.

It focuses on the DCIS phenonema – if you have been reading for a while you’ll know that ductal carcinoma in situ is a ‘cancer’ that wasn’t known before breast screening. It makes up between a quarter and a third of breast cancer diagnosis at screening, and is uncertain in how much or how quickly it will spread, or how much damage it will do.

It’s quite hard for doctors to admit this routinely: it’s a large can of unruly worms. Big trials haven’t been done, so the best treatment is debatable. The NYT article mentions two things: one, that pathologists don’t always get it ‘right’ – but they don’t quite fully express the loitering idea that the ‘right’ answer may only exist in retrospect. Pathologists in meetings will discuss and debate, they want to know things about the patient and the other scans that have been done: they seldom will come straight out with the ‘answer’. This isn’t because they are stupid – in fact, pathologists are usually annoyingly clever – but because they know the limitations of pink stains on slides and because they know how easy it is to get caught out with some things that look much like other things.

Part of the problem is our cultural fear of Cancer – we aren’t used to hearing about how it might not kill you and how it might be something where there are options for treatment.

And the other big problem is not telling women about this possible outcome of breast screening BEFORE she has it.