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Diagnosing Breast Cancer – Negligence In Breast Cancer Management

Would you like to learn more about diagnosing breast cancer? Watch the video below to learn more about what to do when negligence in breast cancer management and a delay in diagnosing breast cancer occurs.

 

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Dr. Kenneth C. Chessick, Medical Malpractice

Delayed Diagnosis of Breast Cancer

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Video Transcript

Timestamps
0:00 Intro
0:20 Diagnosing Breast Cancer: A Delay in Diagnosing Breast Cancer
1:32 Negligence in Breast Cancer Management: A Delay in Diagnosing Breast Cancer
3:21 When To Get A Mammogram: A Delay in Diagnosing Breast Cancer
4:25 Patient Family History
4:55 Genetics
5:55 Physical Examinations
8:46 Stage One Breast Cancer
10:09 Delay Of Diagnosis
12:43 Diagnosing Breast Cancer In A Timely Manner
12:56 Not All Doctors Are Involved In Medical Malpractices

My name is Kenneth Chessick, MD. I’m both a general surgeon and a lawyer that prosecutes medical negligence cases, including negligence in breast cancer management.

 

0:20 Diagnosing Breast Cancer: A Delay in Diagnosing Breast Cancer

As a general surgeon, I have extensive experience in treating breast cancer, and the topic today is negligence in breast cancer management.

Women are frequent victims of medical malpractice, particularly where it applies to diseases of the breast and in particular, breast cancer. Diagnoses of breast cancer are as all diseases are made in basically three ways. The vast majority of diagnoses are strongly suggested by a detailed history which is the most important part of the diagnostic procedures, careful physical examination, and then finally, testing. 

As indicated by the history and physical examination, about eighty percent of diagnoses are made and suggested just by history alone. That’s why that’s so important. Physical examination adds another fifteen percent, and testing will pick up another two or three percent. So the vast majority of tests are indicated based upon a detailed history and careful physical examination.

1:32 Negligence in Breast Cancer Management: A Delay in Diagnosing Breast Cancer

The most common cause of medical negligence related to breast cancer is a delay in diagnosis. It occurs frequently when patients who are at high risk for cancer are not screened for that when the doctor doesn’t identify the factors that make that patient higher risk, and do the necessary examinations, and testing specifically mammograms. That is the most common thing.

What factors determine a high risk for breast cancer? Well, obviously, prior history of breast cancer is number one, family history is another strong indicator, particularly in a sibling, a sister, or in a mother. Race interestingly enough, it also can be a high-risk factor. When compared with white women, non-Hispanic, black women have a forty-five percent higher risk of invasive breast cancers before the age of 50 than do white women. Minority women are 127 percent more likely to die from breast cancer before the age of 50 as compared with white women, and black women have nearly a three-fold increased risk in the most lethal kind of breast cancer, so-called triple-negative breast cancer. So getting the history is critical.

3:21 When To Get A Mammogram: A Delay in Diagnosing Breast Cancer

Frequently, patients, well, they always will identify themselves as at high risk, and that makes a difference as to when you should be doing mammograms. Mammograms should be done, most people say within, before the age of 45. But on high-risk patients, they should be done much earlier. Why are mammograms so important? Mammograms can frequently detect findings of risk suggestive of breast cancer or even highly suggestive of breast cancer. So they are our best screening mechanism in addition to a careful physical examination. As to when that should be begun, identifying who’s at high risk is number one. So the failure to do a mammographic screen screening is really important, and that’s a frequent cause of negligence.

4:25 Patient Family History

I mentioned that one of the high-risk factors is having breast cancer in the patient’s mother or sister. Simply asking the questions of who in your family has had breast cancer, has a sister or a mother had it, is important. Certain other people are at high risk, other minorities including Asians, Hispanics, and Ashford Nazi Jews all are at high risk or can be at high risk, and may indicate a high-risk status.

4:55 Genetics

One of the other high-risk occurrences is genetics, and in particular, in patients who have a family history of breast cancer. As we discussed, and who have had testing themselves, a sister with breast cancer, a mother. One of these common genes are called BRCA1 and BRCA2. They’re the most commonly affected genes that cause both breast cancer or increase the risk of breast cancer and ovarian cancer. On a high-risk individual, genetic testing is indicated to determine that person’s risks.

5:55 Physical Examinations

All right, that’s the second part after history, which as I mentioned, is the most important part of the diagnostic procedure is the physical examination. Many times, patients come in to see their doctors, their family practice doctors, their gynecologists, there are internists, and occasionally even surgeons and they complain of a lump. The patient feels a lump in their own breast, and when that happens, it behooves the doctor to determine is this cancer or is this a benign process. It’s important to palpate the lump, and that means to touch it and feel it, determine whether or not it’s an irregular mass, whether it’s smooth, whether there’s the size of it, whether it’s tender, whether it has associated changes to the skin, what we call dimpling or pulling in of the skin over the mass. Sometimes it’s a matter of blood coming from the nipple of the breast. These are all things that the doctor should identify and should be careful in documenting. Serial examinations are frequently indicated when it’s not clear what this is, but the identification of a suspicious or potentially suspicious mass means that further testing, a mammogram should be done.

Now, there are two kinds of mammograms. There are screening mammograms, people, women should have mammograms every year and the time of starting those might be at age 45 for a Non-Hispanic White person or it might be even earlier as we mentioned for African-Americans and other minorities done annually.

Now, diagnostic mammograms are a little bit different from screening mammograms only in that’s the realm of the radiologist, but the primary care doctor doesn’t do that. He orders a mammogram and it behooves the radiologist to interpret that. 

Delay in diagnosis is by far the most common litigation case that comes in the area of breast cancer. A delay in diagnosis of six months to a year can mean a change in the stage of that cancer from a stage one to a stage three or stage four. 

8:46 Stage One Breast Cancer

Now, what’s stage one? Stage one is where you have a cancer that you can feel or see in a mammogram that’s less than an inch in diameter. We doctors talk about centimeters as does the rest of the world. An inch is two point five four centimeters, so it’s about an inch. If there’s no enlarged lymph nodes under the arm, the axilla, and it’s under two and a half centimeters, that’s a highly curable breast cancer. Sitting and watching that cancer grow to over five centimeters or where it spreads to the lymph nodes, that changes the stage and the importance of changing the stage is that the higher the stage, the less the likelihood of being able to cure that cancer with appropriate treatment. So watching a lump and seeing that it grows, serial examinations every month, for example, can indicate you’ve got to go ahead and get a mammogram and refer it to a surgeon who can put a needle in and get some cells and determine whether this is cancer.

10:09 Delay Of Diagnosis

Delay of diagnosis is by far the single most important factor in determining whether a cancer of the breast is durable. Now, I’ve seen negligence in doctors who examine a woman, feels abreast, and sure she’s got a lump and the doctor doesn’t recognize that and he reassures her that there’s nothing to worry about, and most importantly, does not have her come back in a month or two months for another examination to see whether this mass is now obvious, at least to him. It’s already obvious to her.

Serial examinations not done over months is very common when it comes to primary care doctors. The failure to order a mammogram or the delay in ordering a mammogram, especially when it goes over six months, that is almost always associated with the change in stage and a diminution of the opportunity to cure that patient. One of the common things that a primary care doctor should do if he’s not certain whether he’s dealing with cancer or not is get a consult. Send that patient to a surgeon. 

I’ve had that happen. That’s what creating breast cancer is one of the most common things that general surgeons do. It is the simplest thing to do, to just get a consult, just pick up the phone and say to your general surgeon, “Max, I have a lady that is a mess and I’m not sure what it is. Will you take a look at her?” It is so easy to do and surgeons almost always will determine what that mass is either by serial examination, serial mammograms, or a needle into the mass to get a cell to look at it under a microscope. That will frequently save that lady’s life.

12:43 Diagnosing Breast Cancer In A Timely Manner

These are the most common ways that primary care doctors are negligent and it’s very common in our society. We should be aware, however, that the vast majority of doctors do it right. 

12:56 Not All Doctors Are Involved In Medical Malpractices

Medical negligence claims, amazingly, are disproportionate against a very small number of physicians. Less than two percent of physicians are involved with fifty percent of medical malpractice settlements. Imagine that two percent of doctors disproportionately are negligent and result in cases where they were proven to be careless in their treatments.

So there’s other forms of negligence and I’ll speak about those as they relate to surgical management, radiologic management, radiologists, and by pathologists, and others in a future video like this. 

Thank you. If you have any questions about the things that I’ve discussed here today, feel free to give us a call, thank you.

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