Breast cancer treatment can result in medical malpractice in a variety of ways that many people don’t think about. When a woman has had routine mammograms that come back “normal” and then suddenly receives a diagnosis of an advanced breast cancer, it’s natural to think that the radiologist must have done something wrong to “miss” the cancer. That can well be the case, but not always, and the only way to figure out if this amounts to medical malpractice is to obtain the mammogram studies and have an independent mammographer expert review the images without knowing what eventually happened to the patient. This is called a “blinded review,” intended to reduce the chance for hindsight bias.
But breast cancer treatment also can be too aggressive, and that can amount to medical malpractice in some circumstances. Examples:
Over-diagnosis of breast cancer by inexperienced pathologists.
It’s bad enough to go through the scary and often disfiguring treatment for breast cancer, but imagine if you later discover you never had the cancer. This happens usually because the pathologist whose job it is to look at the biopsy under the microscope lacks experience to make the proper call. This is a big problem with diagnosis of “ductal carcinoma in situ” (DCIS), an early form of cancer that may or may not progress to truly invasive cancer. The criteria for DCIS are sometimes subtle and not all pathologists agree on them. (See our patient safety tips on this issue below.)
Unnecessarily aggressive open biopsies instead of a needle biopsy.
Most breast lumps found in women need to be looked at under the microscope to make sure they’re not cancer. The numbers are large: Of the 1.6 million breast biopsies done every year in the U.S., about one in eight (200,000) results in a diagnosis of invasive cancer, which requires more treatment. That means that about seven in eight women who undergo biopsy receive the good news of no cancer (or the pre-invasive diagnosis of DCIS- ductal carcinoma in situ). Needle biopsy is the gold standard for the initial investigation of most suspicious breast lumps, except for those that a needle cannot reach. It can be done with local anesthetic and a needle stick. Sometimes they need to use x-ray imaging to guide the needle to the right place, when the lump cannot be felt. In that case the needle biopsy is done by a radiologist, not a surgeon. On the other hand, an open biopsy requires a one-inch incision, which leaves a scar, and must be done with either general anesthesia or sedation. It costs about twice as much as a needle biopsy, both for the surgeon’s fee and the hospital’s fee. Researchers believe money could be the motive for the persistently high rates of open biopsies still done in the U.S.
Aggressive removal of lymph nodes.
Recent research has found that many women with early breast cancer do not need to have their armpit lymph nodes removed. This painful procedure has long been routine, because physicians thought removing lymph nodes would prolong women’s lives by keeping the cancer from spreading or coming back. However, the study shows that removing the cancerous lymph nodes is unnecessary when women receive chemotherapy and radiation, which wipes out most of the disease in the nodes.
You should never have any kind of cancer surgery without at least one second opinion on the biopsy. You can have a top cancer pathologist review your tissue slides for a cost of at most a few hundred dollars, and it might even be covered by your insurance. Read More…
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