Watch the video below to learn what occurss during a failure to diagnose breast cancer case and learn more about negligent management of breast cancer.
Learn More:
Diagnosing Breast Cancer – Negligence In Breast Cancer Management
Delayed Diagnosis of Breast Cancer
The Law Office Of Kenneth C. Chessick, MD Earns Tier 1 Ranking From Independent Research Study
Video Transcript
Timestamps
0:00 Failure To Diagnose Breast Cancer: Intro
0:20 Failure To Diagnose Breast Cancer: Negligence In Breast Cancer Management
1:02 Failure To Diagnose Breast Cancer: Mammogram Screenings
2:21 Failure To Diagnose Breast Cancer: Signs Of Breast Cancer
3:21 Negligent Management of Breast Cancer: Benign Mass
4:34 Negligent Management of Breast Cancer: Retraction Of The Nipple
7:20 Negligent Management of Breast Cancer: Medical Negligence Recourse
8:52 Examining Breast Cancer Tissue
10:38 Mastectomy
11:17 Pathologist Diagnosis
11:52 Additional Medical Opinions To Determining Cancer
My name is Kenneth Chessick, MD. I’m a lawyer who prosecutes medical negligence cases as well as a long-time practicing board-certified general surgeon.
0:20 Failure To Diagnose Breast Cancer: Negligence in Breast Cancer Management
Topic today is the negligent management of breast cancer. It’s a continuation of our prior video when we talked about careful history, detailed physical examination, and necessary testing, which should be done by primary care doctors, family practice doctors, internists, gynecologists, and occasionally surgeons.
All of these physicians at some point in management of a lady who comes in with a lump in her breast is going to end up ordering a mammogram.
1:02 Failure To Diagnose Breast Cancer: Mammogram Screenings
Now mammograms are, there’s two kinds of mammograms and they’re done by radiologists. A screening mammogram is a mammogram that’s done on an annual basis on women, white women under starting annually at the age of 45, and minorities, black women, and Asians, and some Ashkenazi Jews done earlier than age 45, age 40, or even 35 on an annual basis. Those are called screening mammograms. But when a lady presents at any age, even in their teens with a lump in the breast, which is she generally identifies by herself presents of the doctor, he now has to decide whether or not this requires further analysis and based upon the history and physical examination, he may order a diagnostic mammogram. That is done by the radiologists. The vast majority of diagnostic radiologists are done properly or not done in a careless negligent fashion, but in some instances, in something too frequently, the radiologist does it and misses the signs of breast cancer.
2:21 Failure To Diagnose Breast Cancer: Signs Of Breast Cancer
Now, what are those signs of breast cancer? Well, one classic is a density in the breast which is discrete and different from the other parts of the breast that is very common. Breast cancers also have some tendency to develop calcifications within the breast cancer as the cancer cells outgrow their blood supply, some of those cells die and the body takes those dead cells and replaces them with calcium deposits. Those calcium deposits can be seen on the mammogram. They have a characteristic appearance. They’re not round and smooth but they’re irregular and they’re bizarre shapes. That’s one finding.
3:21 Negligence in Breast Cancer Management: Benign Mass
The mass itself, a benign mass, a mass that’s not cancer is generally smooth in its borders while the cancer can be irregular and have what’s called spicules or sharp extensions outside from the main mass that is very suggestive of cancer as well. The growth of the mass when you do mammograms on a serial basis, meaning the first one, is not diagnostic and they go ahead and decide to repeat it in a month or two months, and you see changes in the size of the mass or the shape and location of these spicules, these areas of that prolong that protrude from the mass. Those are all signs that this could be cancer, and unfortunately, those are missed. Sometimes you can see dimpling of the skin on the mammogram, and of course, if you can see it, you shouldn’t identify it and call it to the attention of the physicians. That can be another sign of breast cancer.
4:34 Negligent Management of Breast Cancer: Retraction Of The Nipple
And finally, retraction of the nipple where the nipple instead of protruding is withdrawn into the substance of the breast in some degree, that can be also identified on a mammogram as well as on physical examination. It behooves the, it’s the duty of the radiologist to identify these abnormalities, put them together and make a recommendation as to what should be done next. That what should be done next might be something as simple as putting a needle into the breast mass by the radiologist and withdrawing a core of the tissue of that mass, sending it to the pathologist for examination and determination whether that’s cancer. That’s called a needle biopsy.
When these things are not done, they can be the basis of negligence by the radiologists. Now, unfortunately, there can be negligence by other practitioners other than the radiologists and the primary care doctors. The surgeon can be negligent and the surgeon has a what can, in fact, often does have to make an attempt to make a diagnosis with a needle. And if that fails and do what’s called an open biopsy, open biopsies where you go in and the needle biopsy was negative and can be negative, not show the cancer for a variety of non-negligent reasons, but that if it’s a suspicious mass, it still has to be determined whether this is cancer and that doctor, that surgeon has the duty to do that.
So going in and doing a biopsy, what do you make this is often done under local anesthesia, can be done under regional or general anesthesia. It’s generally done as an outpatient and you go in and you make an incision over the mass and you remove the mass. Well, that sounds pretty straightforward, but frankly, sometimes surgeons just miss the mass. They take out the wrong mass, what they mistake what was that irregular breast tissue, and think and they remove that instead of the mass itself. Of course, the cancer is still there and it continues to grow, and subsequently, three months, six months later, it becomes obvious that the doctor was careless and negligent in his biopsy.
7:20 Negligent Management of Breast Cancer: Medical Negligence Recourse
Now what he should do when he takes out this massive, particularly if it’s done for an abnormal mammogram finding calcifications, for example, is he should give that mass and x-ray it at the time of the biopsy in the operating room or give it to the radiologist x-ray to confirm that those abnormal calcifications that were seen on the magma program that were made this lesion suspicious have in fact been removed. If the doctor does that and those calcifications are not there, he’s got a, while the patient’s still there, go back and find it because it’s his job to determine whether this lady has breast cancer. That’s his duty, and if he doesn’t, does it in a careless and negligent fashion, then he’s responsible for the consequences, which can be and frequently are in the stage of the cancer, and oftentimes, a reduction in the likelihood of cure. Now negligent doctors don’t end with the surgeon. There can be others as well.
8:52 Examining Breast Cancer Tissue
Their pathologist can make being careless in his evaluation of the tissues when the specimen is given off to the pathologist by the surgeon. The pathologists frequently will do what’s called a frozen section, and where they freeze the tissue, slice it, stain it, look at it under a microscope. Now generally frozen sections are thicker than what happens on the permanent sections, and that the specimen is encased in wax and made more rigid and therefore you can slice it into much thinner slices and it makes the viewing of the cells easier to determine whether these are cancer cells.
Well, I’ve seen cases where the pathologist assures the doctor that it’s benign and the surgeon that it’s benign, and then on both frozen and permanent sections, cancer, of course, is not benign. It’s only been a biopsy. There has not been the total lesion removed. The cancer continues to grow and the patient changes stages and may ultimately die as a result of that. Frankly, I’ve seen cases where the pathologist assured the surgeon at the time of the operation and that the biopsy that this lesion was cancer when it was not cancer. The surgeon has to rely on the pathologist to tell him that. That’s not the surgeon who has the ability to look under the microscope and make that kind of determination. And if the pathologist says that’s cancer, then the surgeon may be forced to go ahead and do a much larger breast operation depending on the size of the lesion.
10:38 Mastectomy
Initially, it might involve total mastectomy or even mastectomy and removal of some of the muscles in the chest wall as well as the lymph nodes under the arm. Those are called modified radical or radical mastectomies. Much less of those today, lumpectomy, but frankly, you’ve got to make sure you’ve got at least the margins are free on the specimen that’s removed, which means that there’s no cancer extending to the edge of the specimen. Otherwise, residual cancer can be there.
11:17 Pathologist Diagnosis
So the pathologist is really critical in making the diagnosis of breast cancer. So he has an obligation and a duty to the patient to identify when cancer is present and also when it’s not and be accurate about that.
On the final sections, if the pathologist is not sure he’s looked at the slides under the microscope and he says, you know I think this is benign or I think this is cancer, either one, he needs to be sure.
11:52 Additional Medical Opinions To Determining Cancer
So when he’s not sure, there is a backup for him, and that is that he can then send those slides of the specimen to other pathologists, either in his institution if he’s got quality people in his institution and frequently send them to places that see a whole host of breast cancer more than the typical community hospital, places like the Mayo clinic or the Air Force Institute of Pathologies, Sloan Kettering, Mass General, Rush Medical Center. There’s many excellent centers which will provide second opinions with more experienced people.
But those are the kinds of negligence that can occur. If you think you have any questions about all this or you want to discuss it further, please don’t hesitate to call us.
