4 ms·

My wife got a false positive a few years back, her doctor called her personally to discuss and reassure her that it was not necessarily a problem, just an area

My wife got a false positive a few years back, her doctor called her personally to discuss and reassure her that it was not necessarily a problem, just an area of suspicion. She wasn't all that anxious or worried about it. The worst thing she was worried about was the chance of needing a biopsy, not the chance of actual breast cancer. She went in for a followup ultrasound scan and was cleared. Given the survivability of early stage breast cancer versus late stage, a high false positive rate doesn't seem worse than the alternative of missing early stage breast cancer. Obviously, better imaging or other tools would be even better.

tomrod 5y ago
This is really the tradeoff we face in the binary classification space. Do we want false positives or false negative reduced? There are more sophisticated approaches, but if the costs in one direction are magnitudes more than in another, it becomes a clear preference.
orzig 5y ago
There's also a subtle clinical communication aspect to this. I once had a doctor message me shortly after a routine test and say "I need you to come back tomorrow", and my pregnant wife was losing it until we could get through to him and find out that he just wanted to ensure I hadn't gotten an infection during the test. My wife wasn't wrong to be upset! Several hours of suffering could have been avoided with a good pamphlet.
- colinmhayes 5y ago
  Yep, I've got family members who are doctors and they always tell me that bedside manner is the most important part of their job. They have to go to continual learning conferences every year and the biggest part of them is usually bedside manner stuff.
- Johnny555 5y ago
  Yeah, communication is key - no doubt it would have been a different story if she got a voice-mail from her doctor's office saying "We found a suspicious lump in your mammogram, we're going to need you to come in for a followup tomorrow". She probably would have had a sleepless night wondering how serious it was.
Aulig 5y ago
Unfortunately we treat lots of false positives, which leads to unnecessary chemotherapy and other treatments. These unnecessary treatments harm ones health so much that no study could show an increase in life expectancy by doing regular mammograms.
- dontreact 5y ago
  No one just treats a mammography or tomography positive without other follow up tests. It's not the standard of care. The next step is to get an ultrasound and then a biopsy.
- Johnny555 5y ago
  No one receives chemotherapy from a screening mammogram alone, there are always further diagnostic tests before treatment. Though there are probably unneccessary biopsies. Screening mammograms do reduce breast cancer mortality: https://pubmed.ncbi.nlm.nih.gov/33141657/ https://pubmed.ncbi.nlm.nih.gov/33141657/ Annual mammographic screening at the age of 40-49 years resulted in a relative reduction in mortality, which was attenuated after 10 years. It is likely that digital mammography with two views at all screens, as practised now, could improve this further. There was no evidence of overdiagnosis in addition to that which already results from the National Programme carried out at later ages.
glitcher 5y ago
My wife got a false negative screening and then a few months later was diagnosed with stage 4 metastatic breast cancer. The cost of dealing with false positives seems much less than the consequences of a false negative in our experience, so I agree with your sentiment.
- sebmellen 5y ago
  I hope your wife is doing alright. It is always shocking how quickly life can change.
  - mensetmanusman 5y ago
    Eventually disaster strikes everyone. Knowing this helps me traverse life with humility.
- mh- 5y ago
  My wife is a survivor of stage 3 metastatic. We deal with false positive scares around once a year at this rate, but I'll take them every time over not finding something in time. I'm very sorry about your wife.
conductr 5y ago
> Given the survivability of early stage breast cancer versus late stage, a high false positive rate doesn't seem worse than the alternative of missing early stage breast cancer I stand by this sentiment wholeheartedly. 3D mammo caught a 0.6mm diameter tumor for my wife and she never even felt the lump. I felt it once and then couldn't find it again. I had to drag her to the doctors office as she didn't believe me. Oddly enough, my college years were spent in a pathology lab and I knew exactly what a tumor felt like and knew her family history and my heart sank the first time I felt it, so I was quite persistent in forcing her to see the doctor. They rushed her surgery on the schedule and still the tumor was 3.5mm by the time they removed it. Time is absolutely of the essence. Had she waited for her annual exam or for some convincing evidence that she needed to go to the doctor, I fear it would have metastasized and I'd be a widower writing this comment. I feel like adding, in the US, at the time, we had to fight tooth and nail for the 3D mammo to be covered by insurance and it was still pretty pricey copay. This really should be more widely available. Especially for certain demographic traits. My wife was 30ish (dense tissue), family history, known BRCA+, and should not have to fight for this technology that is the obvious best option.
qiskit 5y ago
The absolute worst thing is false negatives. No tests should allow those. We can live with false positive to some degree. But we should nonetheless try and minimize the false positives since high false positives might do more collective harm than no test at all. What the false positive limit is, I guess it's up to society and the medical profession to decide.

tomrod 5y ago

This is really the tradeoff we face in the binary classification space. Do we want false positives or false negative reduced? There are more sophisticated approaches, but if the costs in one direction are magnitudes more than in another, it becomes a clear preference.

orzig 5y ago

There's also a subtle clinical communication aspect to this. I once had a doctor message me shortly after a routine test and say "I need you to come back tomorrow", and my pregnant wife was losing it until we could get through to him and find out that he just wanted to ensure I hadn't gotten an infection during the test. My wife wasn't wrong to be upset! Several hours of suffering could have been avoided with a good pamphlet.

colinmhayes 5y ago
Yep, I've got family members who are doctors and they always tell me that bedside manner is the most important part of their job. They have to go to continual learning conferences every year and the biggest part of them is usually bedside manner stuff.
Johnny555 5y ago
Yeah, communication is key - no doubt it would have been a different story if she got a voice-mail from her doctor's office saying "We found a suspicious lump in your mammogram, we're going to need you to come in for a followup tomorrow". She probably would have had a sleepless night wondering how serious it was.

Aulig 5y ago

Unfortunately we treat lots of false positives, which leads to unnecessary chemotherapy and other treatments. These unnecessary treatments harm ones health so much that no study could show an increase in life expectancy by doing regular mammograms.

dontreact 5y ago
No one just treats a mammography or tomography positive without other follow up tests. It's not the standard of care. The next step is to get an ultrasound and then a biopsy.
Johnny555 5y ago
No one receives chemotherapy from a screening mammogram alone, there are always further diagnostic tests before treatment. Though there are probably unneccessary biopsies. Screening mammograms do reduce breast cancer mortality: https://pubmed.ncbi.nlm.nih.gov/33141657/ https://pubmed.ncbi.nlm.nih.gov/33141657/ Annual mammographic screening at the age of 40-49 years resulted in a relative reduction in mortality, which was attenuated after 10 years. It is likely that digital mammography with two views at all screens, as practised now, could improve this further. There was no evidence of overdiagnosis in addition to that which already results from the National Programme carried out at later ages.

glitcher 5y ago

My wife got a false negative screening and then a few months later was diagnosed with stage 4 metastatic breast cancer. The cost of dealing with false positives seems much less than the consequences of a false negative in our experience, so I agree with your sentiment.

sebmellen 5y ago
I hope your wife is doing alright. It is always shocking how quickly life can change.
- mensetmanusman 5y ago
  Eventually disaster strikes everyone. Knowing this helps me traverse life with humility.
mh- 5y ago
My wife is a survivor of stage 3 metastatic. We deal with false positive scares around once a year at this rate, but I'll take them every time over not finding something in time. I'm very sorry about your wife.

conductr 5y ago

> Given the survivability of early stage breast cancer versus late stage, a high false positive rate doesn't seem worse than the alternative of missing early stage breast cancer I stand by this sentiment wholeheartedly. 3D mammo caught a 0.6mm diameter tumor for my wife and she never even felt the lump. I felt it once and then couldn't find it again. I had to drag her to the doctors office as she didn't believe me. Oddly enough, my college years were spent in a pathology lab and I knew exactly what a tumor felt like and knew her family history and my heart sank the first time I felt it, so I was quite persistent in forcing her to see the doctor. They rushed her surgery on the schedule and still the tumor was 3.5mm by the time they removed it. Time is absolutely of the essence. Had she waited for her annual exam or for some convincing evidence that she needed to go to the doctor, I fear it would have metastasized and I'd be a widower writing this comment. I feel like adding, in the US, at the time, we had to fight tooth and nail for the 3D mammo to be covered by insurance and it was still pretty pricey copay. This really should be more widely available. Especially for certain demographic traits. My wife was 30ish (dense tissue), family history, known BRCA+, and should not have to fight for this technology that is the obvious best option.

qiskit 5y ago

The absolute worst thing is false negatives. No tests should allow those. We can live with false positive to some degree. But we should nonetheless try and minimize the false positives since high false positives might do more collective harm than no test at all. What the false positive limit is, I guess it's up to society and the medical profession to decide.