Delayed Diagnosis of Breast Cancer Leads to Distant Internal Organ Metastasis

This case involves a fifty-six-year-old female patient who was seeing an OBGYN for routine tests to screen for cervical and breast cancer. The physical exam was unremarkable but a mammogram performed the same day showed prominent architectural markings of nodularity along with scattered parenchymal calcifications. The patient was sent for a repeat mammogram because the first images were considered to be of poor quality but the second study showed no abnormalities; the patient was recommended for a repeat study in one year despite complaints of breast discomfort and soreness. The following year the patient went for an annual pap smear and breast exam and informed the physician of a hardness in the left breast. The physical exam revealed thickened tissue with a freely movable non-fixed mass. An ultrasound was performed that revealed an ill-defined lesion in the left breast. A needle biopsy was performed that uncovered an infiltrating ductal carcinoma. The patient underwent a partial mastectomy with left axilla lymph node sampling. Several rounds of chemotherapy using Taxotere, as well as radiation were conducted after an MRI showed progressive cancer spreading to the several internal organs. The patient passed away less than two years after her initial presentation to the OBGYN screening clinic.

Question(s) For Expert Witness

1. Should this patient have undergone other radiographic studies to determine if a malignancy was present after the persistent complaints of breast discomfort?

Expert Witness Response

Female patients complaining of breast pain, especially over the age of forty, are often evaluated through a variety of radiographic studies, however, mammography remains the mainstay of breast cancer screening. The role of the breast ultrasound is often a diagnostic follow-up of a mammographic abnormality because it may help clarify features of a potential lesion. Performing an ultrasound of the breast is generally accepted as the method of choice for the differentiation of cysts from solid masses and for guidance in interventional procedures such as fine needle biopsy. The consensus is that sonography should not be used as a screening tool to evaluate for malignancies. Instead, sonography should be used as an adjuvant to mammography which may increase sensitivity and specificity of diagnosing this patient in the earlier stages of the disease.