Cancer misdiagnosis, how bad could it be?

By Ahmad Fakri

Kuala Lumpur | Tue Aug 27, 2013 4:25pm

(INFOVALLEY) - It is a norm for people to feel afraid when they talk about cancer. According to World Health Organization (WHO), cancer is a leading cause of death worldwide[i] [ii]. Imagine a scenario when a doctor informs a patient that he or she has been diagnosed with cancer. The news might be unbearable for some, they might feel worried, stressed out, lost, scared, angered, sad, and confused. The family will likely react the same, they will be worried and start to feels that they may soon lose their loved ones.

           What if the “cancer patient” is actually cancer free and they are just as healthy as anyone else? This question keeps escalating over the years where people are misdiagnosed for having cancer while they are not.
           
          Misdiagnosis can be defined as the incorrect assessment of a patient’s illness type or stage. Researcher at The Johns Hopkins Hospital in Baltimore reviewed 6,000 cancer patients’ tissue samples in the country and they found one out of every 71 cases was a misdiagnosed; as an example, a biopsy was labeled cancerous when it was not. Furthermore, one out of five cancer cases was misclassified[iii]. 

           In a joint study between Best Doctors and the National Coalition on Health Care (NCHC), entitled Exploring Diagnostic Accuracy in Cancer, 21 cancers were named for the most often misdiagnosed or mischaracterized conditions and the top five conditions by considerable margin was Lymphoma, followed by Breast Cancer, Sarcomas, Melanoma, and Cancer of Unknown Primary Site.

Table 1

                From Table 1, the study showed the top reasons for misdiagnosis to occur were “fragmented or missing information across medical information systems” (38.5%), “inadequate pathology diagnostic resources” (22%), “inadequate genetic/genomic information available at the time of diagnosis” (20.3%) and “inadequate radiology/procedural diagnostic resources”.

             From the statistic it is understandable that the main issue leading to misdiagnosis is lack of diagnostic information. Diagnostic information is crucial as it is one of the main determining tools in medical diagnosis. The information that required for medical diagnosis varies, from clinical information, medical history, genetic information and few others. Thus if the doctors lack any of these information the diagnosis may become a questionable result.

Table 2

                  From this study as well, as in Table 2 the most popular answer by the doctors about the possible ways to avoid misdiagnosis was “new or improved pathology tools and resources” with 36% of respondents, followed by “new or more rapidly accessible resources for tumor genetic testing” with 17.8%, and “new or improved radiology tools and resources” with 15%. 

             The doctors agreed that the improvement needs to be done in terms of upgrading the information resources including pathologic, genetic, radiology, and clinical information. One of the major contributions to the cause of misdiagnosis is insufficient or no genetic (genomic) information available at the time of diagnosis.  As suggested by the doctors, new or more resources for tumor genetic testing should be readily accessible, because more absolute and accurate result on the cancer conditions could be obtained.

               New dimension of genetic screening is now starting to take over the market in the form of genetic predisposition testing. Genetic predisposition test identifies individuals who are genetically predisposed to certain health problems. The physician will be able to  ‘peak’ into the patient’s  genetic make-up and take the necessary steps to help prevent the conditions from manifesting. A genetic predisposition test is considered as one-step-ahead initiative in health screening compared to biochemical based markers that will detect a disease when it has manifested, in the cases of discussion, cancer that is already present in the body. However, tumour marker levels are not always altered in people with cancers, especially in the early stages of cancer. At times, the cause of the elevated levels of biochemical markers can also due to other causes and factors. For example, the level of the tumor marker CA 125 can be high in women with gynecologic conditions other than ovarian cancer. The genetic predisposition test caters for the wellness sector and therapeutic lifestyle interventions with periodic screenings that helps for cancer diagnosis and cancer prevention altogether.

               In cases where cancer is already present at an early stage, genetic tests plays a role to determine the condition, level and seriousness of the cancer accurately. This will create a better decision making in determining the types of treatment a patient should undergo, be it surgery, radiation, chemotherapy or endocrine therapy. In addition if it is surgery, radiation, or endocrine therapy, the test will help to ascertain the type of the treatment that should be performed. For the fact from the study, the genetic test will be able to reduce the chance of misdiagnosis by 20.3 percent and will increase the diagnostic accuracy rates in cancer cases by 17.8 percent. This effective cancer screening will avoid a late detection, economic lost and loss quality of life.

Picture of Kylie Minogue, a cancer ‘survivor’; a victim of misdiagnosis

         American Cancer Society suggested that the second opinion is crucial in determining the cancer status condition and the type of treatment if the cancer is confirmed to be positive[iv]. This message was also expressed by the top Australian multi-talented artist Kylie Minogue during her appearance on The Ellen DeGeneres Show in 2008. She said “Because someone is in a white coat and using big medical instruments doesn't necessarily mean [he or she is] right” (BBC News). She is one of the thousands of patients victimized by misdiagnosis of cancer. She is now busy raising awareness on importance of early detection of cancer and hosting charity for cancer societies. 

           Cancer is preventable. Will and effort in undergoing early screening and seeking for second or maybe third opinion, matters. Don’t take things for granted. Prevention is better than cure.
  
By Ahmad Fakri Hilmi, iGene Sdn. Bhd., KL

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[i] http://www.who.int/mediacentre/factsheets/fs297/en/

[ii] http://publications.cancerresearchuk.org/downloads/Product/CS_FS_WORLD_A4.pdf

[iii] Misdiagnosed cancer not uncommon – ABC News, http://abcnews.go.com/WNT/story?id=131047&page=1

[iv]http://www.cancer.org/treatment/understandingyourdiagnosis/talkingaboutcancer/talkingwithyourdoctor/talking-with-your-doctor-getting-a-second-opinion

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Digital Autopsy and iGene highlighted in Reuters.

Infovalley Group Chief Executive Mathavan Chandran poses at his office in Kuala Lumpur, June 24, 2013.

By Jeremy Wagstaff

SINGAPORE | Tue Aug 20, 2013 5:11pm EDT

(Reuters) - Malaysian entrepreneur Matt Chandran wants to revive the moribund post-mortem by replacing the scalpel with a scanner and the autopsy slab with a touchscreen computer.

He believes his so-called digital autopsy could largely displace the centuries-old traditional knife-bound one, speeding up investigations, reducing the stress on grieving families and placating religious sensibilities.

He is confident there's money in what he calls his Autopsy as a Service, and hopes to launch the first of at least 18 digital autopsy facilities in Britain in October, working closely with local authorities.

Around 70 million people die each year, says Chandran, and around a tenth of those deaths are medico-legal cases that require an autopsy. "That's a huge number, so we're of the view that this is a major line of services that is shaping up around the world," he said in an interview.

The poor common perception of autopsies has undermined their commercial appeal. "Unfortunately, because the process of the post-mortem is seen as gruesome, one tends to ignore that," says Chandran.

Humans have been cutting each other open for at least 3,000 years to learn more about death, but the autopsy has never been widely embraced outside TV crime dramas. Surgeons in 18th century Britain, for example, robbed graves for corpses to dissect, some even commissioning murders when supplies dried up.

By the 1950s, the autopsy was at its zenith, with pathologists performing post-mortems on more than 60 percent of those who died in the United States and Europe - helping uncover more than 80 major, and perhaps thousands of minor, medical conditions.

But the number of autopsies has fallen steadily: Today, fewer than 20 percent of deaths in Britain are followed by autopsy, and most of these are ordered by coroners in cases where the cause of death is unclear or disputed.

The fall has been blamed on a growing distaste for a procedure regarded by some as crude and outdated - a feeling fanned by the public discovery in Britain in 1999 that medical institutions had been retaining organs and tissue after post-mortems for decades.

Digital Autopsy forensic application, a three-dimensional capabilities to view and dissect inside and outside of the digital body in high definition visuals, on a multi touch screen representing a digital mortuary table at the INFOVALLEY office in Kuala Lumpur June 5, 2013.

DIGITAL MAKEOVER

Chandran, 45, wants to change all this by simply connecting his company iGene's 3D imaging software to any standard medical CT or MRI scanner. An expert can then inspect the virtual cadaver in 3D, removing layers of cloth, skin and bone with a mouse or by gestures on a tabletop touchscreen.

The advantages, Chandran says, are considerable.

The digital evidence remains intact and can be reviewed; experts can more easily spot and identify fracture, foreign objects such as bullets, and the tips of knife wounds; and grieving families can swiftly learn how their loved ones died and without having to cut open the body.

iGene isn't the first to run a scanner over a corpse. Radiology has been used on skulls for 30 years, and Israel first introduced the concept of a virtual autopsy in 1994. The U.S. military started conducting CT scans of all soldiers killed in Iraq and Afghanistan in 2004 in addition to traditional autopsies.

The results have been encouraging. Researchers from University College London concluded that in fetuses and individuals aged 16 and younger, a minimally invasive autopsy incorporating an MRI scan identified the same cause of death as 90 percent of traditional autopsies.

A staff member carries out a CT scan on a corpse at a mortuary at Hospital Kuala Lumpur in Kuala Lumpur July 3, 2013.

COMMERCIALISE

But iGene is, Chandran says, the first to package the process and offer it commercially as a suite of services that stretches from the moment of death to the delivery of a post-mortem report.

His company provides a software suite that uses existing medical scanners from the likes of Siemens, General Electric, Toshiba and Philips. These form the heart of iGene's digital autopsy facilities which the company plans to build close to UK mortuaries. The first will open in October in the northern English city of Sheffield.

A spokesperson for Sheffield City Council confirmed it was working with iGene on such a centre, but declined to give details. Chandran says his company will spend around $77 million to build and run the facilities and will make its money from those cases where a coroner demands a post-mortem. About 200,000 deaths require autopsies each year in Britain, he said.

Next of kin will be given the option of a classical autopsy, paid for by the state, or a digital autopsy, costing about 500 pounds ($780) and paid for by the family.

SKEPTICS

Not everyone believes the digital autopsy is ready for prime time. Some question whether it can spot some diseases. And even a pioneer like Guy Rutty, chief forensic pathologist at the University of Leicester and the first to use CT images as evidence in a criminal trial, says that while demand may be growing there are limits to what a digital autopsy can do - particularly determining where and in some cases when a patient died.

"There are centers providing such services, but others have been more cautious and are still at a research stage," he said in an email interview.

Chandran and his team are undeterred. They say the digital autopsy facility combines with other non-invasive diagnostic tools such as angiography and toxicology.

Pramod Bagali, chief operations officer of iGene's parent company InfoValley, says the system is "a complementary method, not a complete replacement" to traditional autopsies, but could handle 70 percent of routine cases. The others could be done digitally to start with and then a decision could be made about whether to open up the body. "It's not replacing one flawed system with another," he says.

Crucially, iGene offers a business model that overcomes concerns that scanning corpses is expensive, says Chandran. He estimates his UK operation will be profitable within three years. But that, he says, is just the start. By then, he says, he hopes to have built at least 10 more facilities in his native Malaysia, with interest also from the Middle East, Latin America and elsewhere in Asia.

"The potential for this is global," said Mark Rozario, CEO of Agensi Inovasi Malaysia, a government body which this year bought a 20 percent stake in iGene for $21.5 million.

SUPPORTERS

Chandran and his supporters see this as the beginning of his innovation, not the end of it. The digital autopsy facilities are nodes in a broader ecosystem Chandran likens to Apple Inc's iTunes.

Michael Thali, a Swiss academic who has been promoting a "virtual autopsy" for more than a decade, said he tried and failed to get the scanner makers interested in developing such services. Now an adviser to iGene, Thali says this leaves open the field to other companies to deliver improvements in the chain of examination.

"The future will be for smaller companies who are bringing a service for this niche," he says. "The most important thing is that you have a real chain based on IT."

This is some way off - and may never happen.

Milos Todorovic, lead analyst at Lux Research and a specialist in medical innovation, says that while iGene's approach is intriguing, it faces hurdles - not least the fact that the company is starting from scratch in an expensive business. "A lot of things would have to fall into place for them to be able to succeed with something like this," he said.

That isn't stopping Chandran from dreaming big - including the idea of scanning the living as part of any regular medical checkup. "Just like a birth certificate starts with the birth of a baby, the end of a person's life will end with a report in which the 3D body of a person is captured," he said. "In that way we can archive every person born on this planet."

(Editing by Ian Geoghegan)

Article Source : Reuters, Aug 20, 2013. 
Pictures by Reuters/Bazuki Muhammad

Edited by Ahmad Fakri

Even healthy-looking smokers have early cell damage which destroys necessary genetic programming

* Smoking causes harm, even when there is no clinical evidence that anything is wrong but cells are already starting to lose control and become disordered

* When you smoke a cigarette, some of the genetic programming of your lung cells is lost and the cells are fertile to develop cancer

Read more at:

Even healthy-looking smokers have early cell damage which destroys necessary genetic programming

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