Stanford computer diagnoses breast cancer more accurately than human doctor

You say "particularly in moderately-differentiated tumors" -- I have a few questions.

1. Why did you specifically point out "moderately-differentiated?" I ask because my wife has a tumor classified as poorly-differentiated. I'm wondering if the middle ground is unique/harder to diagnose in some way.

2. Would something like this come into play during the initial biopsy or after the tumor is removed? I ask because she has a mastectomy next week. I kind of assumed the nature of the cancer was already figured out with the estrogen+ and her2/neu tests. We never really received a "score" - just a breakdown of the good and the bad characteristics and the suggested treatment plan post surgery - which includes both anti-estrogen drugs AND herceptin.

3. Does it make sense, at this point, to try to get her into Stanford for this C-Path test?

Any input is appreciated.

First, my sympathies for your wife, I wish the best outcome for you both. Second, please do not take any of the following for medical advice, I intend to speak generally.

I mostly said moderately differentiated, because for a lot of pathologists, if you give us a three tiered system for grading some type of cancer (and there are systems for almost every type of cancer) that we'll put most things in the middle. I personally believe two tiered systems work better for most everything. Most studies have shown that breast cancer scoring (in the US, most use the Nottingham modification of the Bloom-Richardson system) is only moderately reproducible anyways [1][2]

I tend to only fully grade the tumor after it has been resected, because there is not much point in grading it on the biopsy (ie. it won't change management, most patients are still going to have surgery) since sampling error may influence the final grade if you are discrepant from the biopsy.

I always tell friends and family that if they have any medical procedures, and most especially those for cancer, to always get copies of the operation note and the final pathology interpretation. The operation note will be written by the surgeon and will detail everything she did during the operation, what was removed, what was placed, etc. The final pathology will be the best place to get detailed information about what the tumor, where it is, the pathologic stage, etc. Your discussions with all of the other doctors will all basically be dictated by this report. There may be multiple of them, one for each procedure. So get the biopsy pathology report, the pathology report from the mastectomy, etc. They should also report out the results of the ancillary testing to (ER/PR/Her2) since they are the ones who did them. Most of the cancer reports (in the US anyways) should be written in accordance with the protocols from our professional organization and can be found online [3]. You'll probably find them somewhat tedious, but there is a wealth of information in there [4]. You are entitled to those reports and you really owe it to yourself to get a copy. If your doctor/doctor's staff won't get you one, then you could contact the pathology group directly to obtain one, don't hesitate.

In general, the grade of the tumor is far, far less important than stage of the tumor at diagnosis (most importantly the status of the axillary lymph nodes) and also the ER/PR/Her2 status of the tumor.

[1] http://www.ncbi.nlm.nih.gov/pubmed/15920556

[2] http://www.ncbi.nlm.nih.gov/pubmed/7856562

[3] http://www.cap.org/apps/cap.portal?_nfpb=true&cntvwrPtlt...

[4][pdf] http://www.cap.org/apps/docs/committees/cancer/cancer_protoc...

Is there any reason to watch the videos if one has AIMA? Could one do the assignments without without ever watching a video?

Cars can currently drive themselves in certain limited environments tracks at specially designated competitions. How long do you think it will be before the country has the physical and legal infrastructure to support general-purpose automated cars?

Two thought experiments: 1) Do you think the general public would support the use of self-driving cars on public streets as they operate today, even after seeing the DARPA results? 2) Do you think the general public would support the use of computers to diagnose cancer without involving human doctors anytime within the next 50 years?

Remember that when [specialized worker X] says their job can't be done by [new technology Y], they aren't just referring to the technology being unable to fulfill the task. There is a whole economic, political and sociological matrix on top of the job market that prevents technology from displacing workers, and certain regulated industries are more sheltered than others. The hospital is probably one of the most insulated working environments for technological advances (just take a poke at any of their EMR systems to see what I mean.)

Google's self driving car[1] has logged almost 200,000 miles on real roads. It has a better record than the average driver. A judge in California has deemed that Google is allowed to test on the road as long as they are responsible for the damages. Nevada has already passed laws saying that self driving cars are legal. So in answer to your question, we already have the physical and legal infrastructure to support general-purpose automated cars, and we have the technological capacity.

This shouldn't be a question of the general public supporting it, it should be a statistical question: Are our silicon counterparts better equipped to do the job? If so, then we should have them do it. The day when computers can diagnose cancer better than human's is not far off, and we should welcome it as an indicator of more precise identification rather than shun it out of fear.

[1] http://news.discovery.com/autos/how-google-self-driving-car-...