BREAST CANCER

Cancers of the breast present complex medical and personal issues. With the modern diagnostic techniques of mammography, ultrasound and biopsy, more cancers are being detected at an earlier stage. Because early detection and treatment are believed to provide better survival rates, more women are undergoing breast screening and suspicious lump explorations. In spite of improved diagnostic techniques, however, many physicians still wrongfully believe that they can distinguish the cancerous from non-cancerous lumps "by feel."

Obstetrician-gynecologists are in general agreement that a suspicious lump should not be followed for more than one menstrual period. A lump may be followed for a menstrual period to see if it shrinks or disappears with the passing of the cycle. Where the lump continues beyond the cycle, even though it may prove to be cystic and non-malignant, there is general agreement that such lumps must be aggressively explored and presumed malignant until proven otherwise.

Mammography and ultrasound are useful in identifying the existence and location of lumps (cysts or tumors). However, only a biopsy of the lump can determine whether a lump is cancerous or merely cystic.

GENERAL FACTS:

• Most frequent cancer in women, but it also occurs in men.
• The odds that a woman will get breast cancer are:
  • 1 in 50 by age 50
  • 1 in 17 by age 65
  • 1 in 8 over a lifetime
• Breast cancers constitute 32% of all cancers.
• Breast cancers cause 18% of cancer deaths in women in USA annually.

RISK FACTORS:

• Factors increasing risk of breast cancer (role of hormones) unclear.
• Personal history factors suggesting risk of breast cancer are:
  • Nipple discharge
  • Trauma
  • Fever
  • Present or previous cancer lesions in the breast
  • A maternal history of breast cancer
  • A lump that doesn't go away after a period, or a lump that has pain or increases in size.

In spite of improved technologies, physician failure to diagnose breast cancer is one of the most common claims of medical malpractice faced by obstetricians/gynecologists. The suspicious lump that is "followed too long" (more than two months); the "suspicious lump" that is determined to be cystic and non-cancerous by feel alone (and not biopsied); the "suspicious lump" accompanied by nipple discharge, or pain; or the "suspicious lump" that increases in size, in the face of physician complacency, are all situations, if a cancer is later found, that warrant a medical-legal investigation to determine whether medical malpractice occurred.

Because the medical/scientific literature shows improved chances of survival with early diagnosis and treatment (surgical, chemical and/or radiation) a physician’s failure to aggressively investigate "suspicious lumps" may result in the patient having to undergo more extensive surgery or treatment, or indeed, suffer a loss of life. Because breast cancer is treatable, a physician’s failure to timely diagnose and treat the "suspicious lump" may result in a successful malpractice claim.

In cases were the failure to diagnose breast cancer occurs, the 1995 Physician Insurers Association of America (PIAA) Breast Cancer Study shows that:

• The patient discovered the "suspicious lump" in 60% of cases
• The most common presenting symptom: painless mass (46.5%)
• No suspicious symptoms were reported (16.6%)
• No physical finding in 1/5 of cases (21.4%)
• 80% of the mammograms were negative or equivocal
• Most "suspicious lumps" were discovered by the woman during self examination.

The most common reasons for delay in diagnosis were:

• The physician was unimpressed by "suspicious lump" (35%)
• The patient failed to follow up with the physician after the discovery of symptoms (e.g. "suspicious lump" or nipple discharge)
• A falsely negative mammogram (25.8%)
• A misread mammogram (27.7%)
• The failure of the physician to biopsy (27.7%)
• The delay or failure of the physician to request a surgical consult

From the findings of the 1995 PIAA Breast Cancer Study, it is apparent that a significant number of cases involving the failure to diagnose, or a delay in diagnosing breast cancer, are the result of physician error. In any case where there has been a delay or failure to diagnose breast cancer and subsequent treatment provides evidence of spread to the lymph nodes, a medical-legal investigation is warranted. <back

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© 1999 CHARFOOS & CHRISTENSEN, P.C. Updated: January, 2011