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Woman Develops Cancer After Preventative Requests Denied

Despite her proactive stance in trying to prevent cancer, a woman’s request to have her ovaries removed was continually denied. Several years later she developed both ovarian and breast cancers and was devastated by a very poor prognosis.

This woman in her early 40s had a family history of breast and ovarian cancers and because of this history sought to have her ovaries removed.

She first met with an oncologist and genetic counselor to discuss her family history and her options. Genetic testing was discussed as an option but was not pursued.

A year later she went to a new gynecologist for annual breast and pelvic exams, which were normal. Despite her request to have her ovaries removed, the gynecologist advised against an oophorectomy for two reasons: her ovaries appeared healthy and she needed the estrogen due to her high risk for osteoporosis.

Within one year, the woman was diagnosed with ductal carcinoma in situ, which is the most common type of non-invasive breast cancer. Her oncologist updated her family history to include her breast cancer diagnosis, her sister’s breast cancer diagnosis at age 46, and her grandmother’s ovarian cancer diagnosis at age 52, which was information she had provided inconsistently during prior history takings. The oncologist prescribed Tamoxifen for her.

Six months later, during her annual physical, her gynecologist discovered a mass between the rectum and vaginal septum. The gynecologist said he would evaluate the ovaries during a laparoscopic surgery to remove the mass. He said he would biopsy and possibly remove the ovaries only if they looked abnormal. During surgery, the mass was deemed to be benign; the ovaries appeared healthy and were not removed.

During her annual gynecologic exam the following year, the woman again discussed removing her ovaries. The gynecologist advised against it as long as she was still menstruating, and because she was already showing early signs of osteoporosis. The gynecologist was unaware that the patient was taking Tamoxifen for breast cancer, which countered the estrogen benefit of maintaining the ovaries.

Six months later the woman complained of lower pelvic pressure and pain and was diagnosed with ovarian cancer. She had to have a total abdominal hysterectomy, bilateral salpingo-oophorectomy, and sigmoid colectomy. She was found to have extensive additional cancer involvement throughout her pelvis, and her five-year prognosis is poor.

Her gynecologist settled out of court in this failure to diagnose ovarian cancer lawsuit for more than $1 million.

This was a successful medical malpractice claim based on the following factors:

The gynecologist did not remove the patient’s ovaries when he evaluated them during laparoscopic surgery. The defense’s medical experts said the condition of her ovaries did not meet the criteria for removal, but a conclusive diagnosis of the ovaries was not possible through visual observation so that argument was successfully rebutted. Further, at the time of surgery, the woman had breast cancer, was taking Tamoxifen, had a strong family history of breast and ovarian cancer, was already perimenopausal, and had requested an oophorectomy.

Poor record keeping. An important reason the gynecologist wanted to save the woman’s ovaries was to maintain her estrogen levels. However, the gynecologist was not aware that the woman was being treated with Tamoxifen, which was lowering her estrogen. If the gynecologist had updated the woman’s medical and medication history on an annual basis like she should have, she would have discovered the woman was on Tamoxifen.

The gynecologist denied the patient’s request to have her ovaries removed. The woman wanted to prevent the onset of ovarian cancer. The gynecologist wanted to preserve her healthy ovaries to help prevent osteoporosis. If the gynecologist had not just flatly denied the request and engaged in meaningful discussion with the woman, the discussion may have revealed the Tamoxifen treatment and obviated the need to maintain the ovaries.

Providers did not share information. The oncologist and gynecologist did not share critical information about this woman’s treatment. The woman did not discuss her desire to have her ovaries removed with her oncologist, and did not mention her Tamoxifen treatment with her gynecologist. A system that counts on only the patient to convey relevant information is as prone to error as one that excludes the patient. Sharing information and following up with other providers is an important part of treatment.

Limited documentation. The gynecologist had very little documentation about the woman’s concern about ovarian cancer and therefore less of a defense. The written medical documentation serves as a reminder of the clinician's thought process.

For more on patient safety issues, see the library of articles by Daytona Beach medical malpractice attorney.

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