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A Recurrent Theme:

Failure To Timely Diagnose Breast Cancer

 Failure to timely diagnose breast cancer in a woman is a leading cause of malpractice suits. Surgeons are not the usual target. Family practitioners and gynecologists are the ones usually sued.

In the typical scenario, a woman goes to a family practitioner or a gynecologist and complains of a lump in one of the breasts. The doctor notes something in the breast and draws a picture in the chart showing the location of a small mass. The doctor then recommends a mammogram. The mammogram is reported as negative. The doctor then tells the patient that there is no sign of cancer and either discharges the patient or tells the patient to return in three, six, or twelve months. The patient later goes to another doctor six to twelve months later and a biopsy is done which shows cancer of the breast. A chest x-ray film and a bone scan confirm bone metastases.

The patient then sues the first doctor alleging failure to timely diagnose the breast cancer. The plaintiff (the patient) and her attorney then consult an expert who states that any mass in the breast must be made to go away by either aspiration or biopsy and removal. The expert then points out that a palpable mass of the breast which is cancer does not show up as cancer on the mammogram four to eight percent of the time. The expert further testifies that if the cancer had been diagnosed at the time the mass was first discovered by the patient and confirmed by the sued physician, it could have been removed prior to its spread to distant locations in the patient's body.

This type of case almost always is settled because it is difficult to convince a jury a reasonable physician would allow a mass to remain in a woman's breast.

 The risk management tip is: always resolve a breast mass. If there is any question about a mass, obtain a consult with a general surgeon. Be knowledgeable about the recommendations of the American Cancer Society and the American College of Surgeons concerning indications for and frequency of mammography. When a patient does have a cancer of the breast, be sure to explain the options of chemotherapy as adjuvant therapy or obtain an oncology consult. Always document this information.

Note: The above was written by Dr. Palmisano in 1990 and appeared in the HAPI/PIP edition of the The Medical Risk Manager newsletter, November 1990, Vol. 2 Number 2. The advice given in that article has been confirmed by a study of 487 breast cancer malpractice paid claim cases reported in June of 1995 by the Physicians Insurers Association of America in the PIAA Breast Cancer Study. 83.5 percent of these cancer patients had mammograms and the mammogram was reported as negative or equivocal in 80 percent of these patients. More information about the PIAA study report is available from the PIAA (202)223-2223.

D.J.P.

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