Failure to Diagnose or Detect Cancer

Did you know that doctors miss tumors on mammograms at least 30% of the time?

Doctors claim that diagnosing breast cancer on a mammogram is a formidable task. Statistically, between 6-10 cancers are expected to be seen by mammogram in the first year of screening, however, some cancers can be completely invisible. On the other hand, most studies suggest that at least 5 to 15% of cancers that are potentially detectable by mammography or clinical examination will be overlooked by the radiologist. Some studies suggest that as many as 40% of cancers are visible in retrospect on an earlier mammogram. Although breast cancer may be less common or more difficult to detect in younger women, they make up a greater proportion of plaintiffs in failure to diagnose breast cancer cases. Doctors may even be less impressed by a young patient’s complaints and assume patients’ masses are simply fibrocystic changes. So, statistically, cancers in younger women tend to be ignored. Mammography issues usually fall into two types of cases, namely a failure of communication with the primary care physician and a misreading of the mammogram.

The most prevalent reason for a delay in diagnosis is the failure of the physician to be impressed by physical findings. This accounts for 35% of all breast cancer cases. The second most frequent reason for the delay in diagnosis is a failure to follow-up with the patient in a timely fashion, following a negative mammogram report, a misread mammogram, failing to do a proper biopsy, and a delay or failure to request a second consultation.

What should you do?

Make sure that your physician documents all of your complaints relative to your breast and ask your doctor if there is need for further diagnostic studies. It’s also very important to inform your physician about your family history, and to advise your physician whether or not you have had any prior mammograms. Many cancers are missed because radiologists frequently didn’t know about previous mammograms or failed to compare previous mammograms with the current film. It is extremely important to keep your follow-up appointments. Women who fail to keep follow-up appointments could be compromising their health, especially if they have cancer and it goes untreated. Keep in mind that a tumor can double in size every three months. If your doctor can palpate (feel) a mass that your mammogram cannot detect, your doctor is required to do a biopsy. Pregnant women can also have a high incidence of developing breast cancer. If you are pregnant, diagnostic testing can still be performed. Mammograms can sometimes be of poor quality because of patient movement. If the patient moves during the mammogram, a tumor may not be seen, especially if cancers develop in the chest wall. Make sure you follow the instructions of the technician doing the study to ensure that your chest wall appears in the mammography field.

What should your primary care physician do?

Doctors should not abandon diagnostic test because of unimpressive physical findings. Doctors should perform thorough breast exams on each female patient as part of a physical examination, regardless of age or complaints. If a mass is palpated or suspected, additional studies must be done to rule out malignancy. Be sure that patients understand the need for subsequent studies, and document this fact. Perform regular follow-up examinations on patients who present with complaints related to the breast.

What should your radiologist do?

If a mammogram results in a film of poor technical quality, repeat the study. If the mammogram results are equivocal, recommend a repeat study, additional views, follow-up studies, other imaging modalities, etc., as appropriate. Be sure an adequate physical examination was performed and documented. Compare the results of the present study to all previous studies that were performed. Promptly report your findings to the referring physician; if the patient was self-referred, the results of the study should be directly mailed to her. (If there is any suspicion of an abnormality, the patient should also be advised and told to consult promptly with her primary care physician or an OB/GYN.) If you are performing a screening mammogram on a self-referred patient, be sure to do a thorough breast exam, or advise the patient of the importance of a physical breast exam to complement the mammographic study. In cases in which the patient is self-referred, the radiologist is responsible for ensuring she receives proper follow-up visits.

What should your surgeon do?

When a patient is referred, always perform an adequate examination and document your findings, especially when the referring physician’s findings were unimpressive. When performing a biopsy, be sure the correct lesion is removed, in both open and needle procedures. A specimen x-ray of the biopsy should always be obtained. Promptly report consultation and biopsy results to referring physicians. Many times referring physicians are difficult to reach by telephone. Calls to the referring physician should be documented.