Breast Cancer/BIRADS

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Expert: - 1/2/2007


Question
My doctor told me that 60% of lesions labeled as BIRADS 5 are cancerous.  Yet everything I've read on-line says BIRADS 5 findings have a high probability (at least 95%) of being cancer.  Would a doctor intentionally mislead a patient?  Now I don't know if I can believe what he says.  

Answer
Yes, certain radiological clues indicate a higher or lower probablity for breast cancer. Birad 4 is called suspicious and a cancer risk of around 20 % is claimed, BIRAD 5 is highly suspicious for breast cancer and a risk for cancer of more than 80% is claimed. But all such materials deals with vast number of cases. It is not of much help when dealing with a single case! Furthermore X-ray pictures do not give us any firm cancer diagnosis. The only way to get that is by a biopsy, easiest & quickest by a needle biopsy. If mammography always was combined with MRI & ultrasound scans and biopsies (mostly needle biopsies) of ALL significant lesions a very high diagnostic security would be obtained! A discussion of BIRAD should not be allowed to become too scholastic. It is an easy rule of thumb method. But the firm basis of diagnosis remains as before to be the biopsy!
Maybe he was himself misled? The important lesson here is to do biopsies even when the signs of cancer are not that evident to be on the safe side. With needle biopsies that is not too difficult or expensive or time consuming!

Breast Cancer

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Claes-Gustaf Nordquist, M.D.

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I`m a doctor of medicine and a specialist in radiation therapy and medical oncology. I have long experience in diagnostics and treatment of breast tumours.

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I'm a Doctor of Medicine and specialist in Medical Oncology and Radiation Therapy educated & trained in Sweden. Now retired. Background in Radiation Therapy, Medical Oncology, Radiation Protection, Nuclear Medicine, Diagnostic Radiology, Gynecological Oncology, Clinical Pathology, Clinical Cytology,Hematology and Internal Medicine. M.D. from the faculty of medicine, Royal Karolinska Institute, Stockholm, Sweden. Have also been an exchange student at the Hebrew University, Hadassah Medical School, Jerusalem Israel. Former medical consultant, Swedish National Board of Radiation Protection. Former Police Surgeon and Medical Examiner, Stockholm Police Department. Former Chief Medical Officer, The Royal Guards, The Royal Horse Guards and the Royal Household Brigade, Royal Swedish Army Medical Corps.You can also reach me on: http://www.lifestylerescue.com/expert/health-fitness-advice/dr-claes-gustaf/128 I have no restrictions on the number of questions there.

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