Article: Breast Cancer - Medical Litigation News

BREAST CANCER

Alleged delay in diagnosis of carcinoma of the breast is the single most lucrative and second most common cause of medical malpractice litigation in the United States[1]. In 1990 breast cancer accounted for more than a quarter of malignancies litigated, at an average cost of $210,000.

Plaintiffs are generally young: only about 7% of breast cancers occur in women under 40, but these account for at least 40% of the claims[1], [2]. 84% of payments in the 1990 study were made to women under 50.

In recent medicolegal reviews[3], [4], four-fifths of the plaintiffs had discovered a breast lump. In more than half, the physician was insufficiently impressed by abnormalities on physical examination.

The second commonest reason for delay was a negative mammogram report. Many lawyers and some doctors do not appreciate that negative mammography[4a] is largely irrelevant to the clinical management of a palpable change in the breast[3].

PRACTICE POINT
A negative mammogram does not alter the need to biopsy a breast lump.

Establishing causation can be more difficult[4b]. The average doubling time for breast cancers is about 4 months[5]. - most tumours have existed for 8 years before diagnosis[5a]. Periods of quiescence of up to 5 years and periods of accelerated growth make this common cancer particularly unpredictable[5b]. Some experts have questioned whether delays of a year or more in treatment predictably alter prognosis[6], [7], [8].

Chemotherapy for breast cancer frequently includes doxorubicin (adriamycin), which causes serious heart muscle damage in a small minority of patients. Monitoring the heart during therapy cannot yet predict whether such heart damage will occur⁹.