Failure to Diagnose Breast Cancer
Failure to Diagnose Breast Cancer
Through medical malfeasance (or misbehavior), an improper breast cancer diagnosis can be made, or a proper one can be made late. If this occurs, it is appropriate for the patient or her estate to contact a medical malpractice attorney to pursue a claim. While less common, men can also suffer from breast cancer. The risk of breast cancer is significant; indeed, some studies show that one in seven women will have breast cancer.
A patient generally discovers breast cancer in one of two ways. One way is by the woman herself during a self-examination, which should be performed on a monthly basis. Such an examination may reveal a change in breast tissue such as lumpiness or a single lump. A woman may also experience discharge from the nipple. If a lump is discovered during a pregnancy, there is even greater urgency to seek medical consultation as soon as possible because the hormonal changes during pregnancy can accelerate the growth of a malignancy and options for treatment must be discussed with the baby’s safety in mind. See “Evidence of poorer survival in pregnancy-associated breast cancer” published in Obstetrics & Gynecology, 2008 Jul;112(1):71-8). The second way to discover the presence of breast cancer is through an examination by a gynecologist or through a mammogram. Women age 40 and older should have regular mammograms. Self-examination is not an adequate substitute for mammography.
Should a clinical examination reveal a suspicious change in the breast tissue, the examining physician should make a referral for proper follow-up examination. Some referrals will be for a mammogram. Others may warrant referral to a breast surgeon for needle aspiration (where a needle is used to collect or drain tissue) of a mass, or other form of biopsy.
Mammograms are performed for two purposes. One is a screening mammogram where a patient undergoes evaluation when she has no symptoms indicative of breast cancer. Her breast x-rays are compared from one exam to another to see if there are any changes. With a screening mammogram, usually two images are taken of each breast. If a screening mammogram shows that there have been changes from a prior study, then the patient may undergo a diagnostic mammogram where many more images of each breast are taken and there may be a magnified view of certain areas.
Mammogram findings may include a mass, the size, shape and contours of which may be indicative of cancer. A mass that is round and smooth and has clearly defined edges may more likely be benign. A mammogram may also show calcifications, which reflect the buildup of mineral deposits. Macro calcifications are large calcium deposits typically attributable to the normal aging process, while micro calcifications are tiny specks of calcium frequently associated with rapidly dividing cells, which may be indicative of cancer. A majority of micro calcifications are benign, but they must be analyzed. Depending upon the extent of calcification, the treating physician may need to order a different type of mammogram that permits a more detailed examination of the breast, and another screening mammogram within six months, or further testing such as an ultrasound, PET scan or a biopsy. It is very important for a patient to understand that a mammogram is not failsafe. As many as 80 percent of women diagnosed with breast cancer had a false negative interpretation of the mammogram. False negative mammograms may be the result of a) dense breast tissue which makes the images difficult to read; b) technical problems with the equipment; and c) interpretive errors by the radiologist. Regardless of the outcome of a mammogram, it is critically important that a woman remain vigilant in performing routine breast self-examination.
An interpretive error in reading a mammogram would be the basis for a legitimate lawsuit filed by our team of medical malpractice lawyers in Stamford, Connecticut. To help avoid such errors, radiologists should: double read mammograms, use Computer Aided Detection (“CAD”), and use ultrasound and digital mammography. Suspicious lesions may also be detected using magnetic resonance imaging (“MRI”) with contrast and Molecular Imaging.
In addition to mammograms, there has been an increase in the use of magnetic resonance imaging (“MRI”). The MRI is a more sensitive diagnostic test than the mammogram. The American Cancer Society (“ACS”), in an article date March 28, 2007, has advised that women who are at a high risk for developing breast cancer should be screened by MRI in addition to undergoing mammography. It is estimated that MRI can detect an additional 3% of malignant lesions not detected by mammogram. The American Cancer society does not recommend MRI screening for all women, as the MRI can also be responsible for many “false positive” readings. These mean that questionable areas may be identified that, in the absence of the increased risk, may not be cancerous at all. One might question the efficacy (effectiveness) of such a recommendation, but it may be important for a standard of care issue in a malpractice case. However, many women may want to choose to have the more thorough evaluation. This is particularly true in light of a peer reviewed study published in the August 11, 2007 issue of the internationally renowned British medical journal The Lancet. That study reports successful identification of ductal carcinoma in situ (“DCIS”) in 92% of the cases evaluated by MRI, as compared to a 56% successful detection rate by mammography.
High risk categories have been identified by the ACS to include women:
- who have either the BRCA1 or BRCA2 gene mutation.
- who have a close relative including parent, child or sibling with the gene mutation mentioned above.
- who are at an increased risk for developing breast cancer based upon familial risk factors.
- who had radiation to the chest between the ages of 10 and 30.
- who have or have had a close relative who has Cowden syndrome, Li-Fraumeni syndrome, or Bannayan-Riley-Ruvalcaba syndrome.
In an article published in the “Journal of the American Medical Association” on May 14, 2008, the use of breast ultrasound in conjunction with mammograms was identified as effective in indentifying more breast cancers in high risk women than with the use of mammography alone. While ultrasonography was also noted to be responsible for more false positive reports, the anxiety produced by a false positive may be outweighed by the greater certainty in avoiding a delayed diagnosis of breast cancer.
Women should begin annual breast examinations and mammograms at age 40, and women at high risk should begin such examinations plus MRI exams by age 30, unless other recommendations are made by their physicians.
If the physician(s) fail to diagnose breast cancer in a timely manner, the outcome could obviously be disastrous. Our medical malpractice attorneys in Stamford, Connecticut will attempt to prove the validity of your claim based upon expert testimony concerning both the breach of the standard of care and causation. Causation is essentially a determination of the probable outcome of the disease, had it been diagnosed in time, and comparing it to the outcome or probable outcome given the delay in the diagnosis.
Countless variables can affect the viability of a medical malpractice case, including the staging of breast cancer; involvement of lymph nodes; spread of disease to other organs; potential treatment including chemotherapy and surgery, family history; and general medical condition. It is critical that these issues be explored by competent medical malpractice lawyers to be successful in a claim for failure to diagnose breast cancer. Contact our firm in Stamford, Connecticut to learn more.
For more information about breast cancer, the following are informative web sites: