Missed Breast Cancer Diagnosis Prevents Effective Early Treatment

This case involves a woman in her thirties with a family history of breast cancer who was referred to a regional cancer center by her primary care physician after he detected a lump in her breast. While under the care of physicians at the medical center, the woman underwent a number of imaging studies, including a mammogram and an ultrasound, both of which were read as normal. As a result, she was cleared of a cancer diagnosis and was released without follow up. Some months later, the woman was seen by another doctor, who again ordered imaging studies after feeling a number of lumps in her breast. The patient was seen by a different oncologist, who informed the patient that the imaging performed by the original oncologist had been administered incorrectly, and the results had been misinterpreted. By the time the patient’s cancer was successfully detected, her tumor had more than doubled in size, requiring a double mastectomy as well as multiple rounds of chemotherapy to treat.

Question(s) For Expert Witness

1. Do you routinely treat patients similar to the one described in this case? Please explain.

2. Have you ever had a patient develop the outcome described in the case?

3. Can a delay in diagnosis of this amount of time impact a patient's course of treatment?

4. Please tell us why you're qualified to serve as an expert reviewer on this case.

5. Have you ever been the target of a malpractice claim?

Expert Witness Response E-000029

First, the standard teaching is that a palpable mass requires a biopsy irrespective of the results or ultrasound and mammography. Second, based on the rapid growth, I would estimate that the stage was I at initial presentation and now is T2N0, or stage II. Prognosis, however, is not greatly different between these stages: 100 versus around 90% respectively. It is possible that the prognosis of stage II in this case was actually worse, since it appears to have been rapidly growing. In stage I, chemotherapy is usually not required, so the need for chemotherapy is one of possible damages. I don't know why a bilateral rather than unilateral mastectomy was performed, and this may be another consequence of the delayed diagnosis. In my practice I routinely treat patients similar to the one described in this case and I have special experience in breast cancer and have published and done research in this area.