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Wrong Test Leads to Delay in Diagnosis of Breast Cancer, Million Dollar Settlement

Patients depend on their doctors to order the correct tests and screenings and to be up front and honest about their prognosis. Patients expect their doctors not to overlook things or give them false hope.

Despite doing what all women are taught to do - report any suspicious breast lumps to their doctor - this woman in her 30s had diagnosis and treatment delayed a year because her doctor ordered the wrong type of mammogram.

This 38-year-old female went to see her OB/Gyn after noting a lump in her left breast while showering. During that visit she told her doctor she was concerned because a close friend had died of breast cancer. The physician performed a breast exam. Finding no abnormalities, he ordered a screening mammogram,

The woman went for her mammogram three months later. Even though she had identified a lump herself, she marked the "no abnormalities" box on the radiology questionnaire, because her physician had not identified any on exam.

The results from the screening mammogram noted: "very dense stromal pattern, which reduce the sensitivity of the study for detection of cancer; there is no focal abnormality or other findings suggestive of malignancy – recommendation: annual screening".

Three months later she visited her physician again when she thought she might be pregnant. Her doctor did not review her mammogram results, nor did he examine her breasts or inquire if the patient had noticed any other changes.

The woman returned to her physician for her annual exam six months later. She told her doctor that she could still feel the lump in her breast, and that her periods had now become irregular. An ultrasound detected a 2.5 cm mass in her left breast. Mammogram, biopsy, MRI and laboratory testing revealed a Stage IV, invasive, ductile breast cancer with metastasis to her spine.

Also noted at this time was the woman’s fairly strong family history of breast cancer; a maternal aunt diagnosed at 50 and a paternal cousin diagnosed at age 36. Prior to this visit, the woman’s family history of breast cancer had not been documented.

The woman has since undergone a radical mastectomy with axillary dissection, radiation therapy, chemotherapy, and a bilateral oopherectomy. She also sustained multiple compression fractures because of the metastasis to her spine.

The woman filed a lawsuit against the radiologist and radiology center that conducted the mammogram when she first discovered the lump, alleging a delay in diagnosing her breast cancer that led to a poor prognosis. The case was settled for $1 million.

This woman had a strong medical malpractice case based on the following factors:

Physician ordered a screening mammogram rather than a diagnostic mammogram. When the woman discovered a lump in her breast, her physician ordered a routine screening mammogram, which lead to inadequate imaging, poor evaluation, and inadequate follow-up of a breast problem. Even without the physician’s knowledge of a family history or confirmation of a lump on physical exam, the work-up should be aggressive until the complaint is resolved.

Important clinical info was not included on the test request. Providers should include all pertinent information regarding the reason for testing and any important patient complaints or physical findings. A patient’s history of feeling a lump in her breast — and the location of that lump — should be noted on the imaging request.

Physician’s inability to palpate a lump on physical exam falsely reassured the patient that there wasn’t a problem. Guidelines require an aggressive work-up of all breast lumps, even when the physician doesn’t concur with the patient’s complaint. The patient said she chose “no abnormality” response on the imaging questionnaire because her physician had examined her breasts and found nothing unusual.

Physician’s failure to obtain a complete and up-to-date family history. A patient’s family history often provides the first clues that he or she may be at high risk and is in need of more rigorous screening and assessment of complaints. A patient with a strong family history of breast cancer should receive annual breast exams and annual mammography 5-10 years earlier than her youngest affected relative, which in this case was her 36-year-old cousin.

Poor follow-up and review. The woman thought she was pregnant and went to see her doctor, who failed to review the results of her recent mammogram with her, examine her breasts or inquire as to whether she had noticed any other changes. Follow-up of previous complaints is important to the coordination of patient care and to ensure that things don’t fall through the cracks.

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

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