Medical Malpractice-Breast Cancer Awareness Month
Breast Cancer Awareness: Is it Possible to be Over-aware?
Breast cancer awareness month has just passed. The importance of regular mammograms for cancer prevention is one of the mottos of this battle for cancer screening. Most cancer is treatable if it is caught early enough in the process. The stories related to this terrible disease are very tragic, and stress the importance of early detection. We've all heard or known about someone who was too afraid to go to the doctor until it was too late. This illustration has been talked about many times in cancer prevention month. A woman too afraid to go to the doctor delays getting treatment, thinking she could walk-off the lump in her breast until she fell so sick that she finally had to see her health professional. Once at her doctor’s office the woman learns that she has breast cancer, which by now has spread throughout her body. Her chance of survival is low now, and it is dependent upon the success of a rigorous course of surgeries and chemotherapy treatments. The worst part of this story is that the woman would have had a 100% chance of survival if she had come in when she first noticed a problem.
And that story is only the beginning. There are a plethora of tragic stories related to this disastrous illness, such as the woman from Sydney, Australia who recently was awarded a mere $400,000 after a breast cancer misdiagnosis. The woman went to her doctor for an annual mammogram. A lump showed up in the mammogram, but she was reassured by her doctors that it was benign and nothing to worry about, only to later find out that the lump had been cancer, which by that point, had metastasized to her lungs and her brain. These stories are incredibly tragic, and hopefully, breast cancer awareness campaigns, such as breast cancer awareness month, will reduce the incidence of such horrible occurrences in the future.
Regular mammograms are widely heralded as the key in breast cancer awareness. But how reliable is this technology?
Mammograms are certainly useful in the early detection of breast cancer, but to call the technology a golden bullet is going much too far. A study by the U.S. Preventive Services Task Force indicates that a random selection of 1,000 women must receive screenings for 14 years for one woman to be prevented from dying due to breast cancer.
It makes sense that when there are more women receiving regular mammograms there will be more women receiving treatment for breast cancer. However, there have been a number of studies which indicate that mammograms and other breast cancer screening technologies can actually over-diagnose patients. In spite of the great deal of stories about failed diagnosis, mammograms can actually diagnose patients as having life-threatening tumors when, in fact, they are perfectly healthy. This is called over-diagnosis, and can result in women without cancer undergoing painful radiation and surgical treatments unnecessarily. A recent study in the British Medical Journal has compiled a few statistics about the likelihood of over-diagnosis. This study suggests that in a population of 250 (assuming an 8% chance of getting breast cancer) regular mammograms will protect one of the women from a death due to breast cancer. However, the mammograms will also result in the over-diagnosis of two women. The study further indicates that there is no way to distinguish between the three women.
There has also been some discussion in recent literature regarding the utility of magnetic resonance imaging (MRI) in screening for breast cancer. Some studies have been interpreted as recommending this technology over mammograms. However, MRIs are plagued by the same problems of over-detection which affect mammograms. In fact, MRIs cannot even detect all of the types of cancer which can be detected through a mammogram. A recent study found that an MRI could detect 32 types of cancer, but missed 13 other types. Eight of the 13 types that the MRI missed were detected by the mammogram. Additionally, MRIs may also detect normal cyclic hormonal changes as cancer. Doctors recommend that patients who use MRIs for breast cancer screenings use facilities which can also perform MRI-guided needle localizations and MRI-guided core needle biopsies. Another screening tool, sonography, is being tested for its utility in initial breast cancer screenings. The technology is currently used to monitor cancer after it is diagnosed. However, medical professionals agree that the best method of breast cancer screening is a physical examination coupled with a mammogram.
Although mammograms are capable of such over-detection the amount of medical professionals that are capable of performing the procedure is diminishing. Radiologists feel that they do not have much of an incentive to offer the procedure because the cost of performing it is higher than the Medicare reimbursements they receive. Additionally, they fear large liability lawsuits if in fact they do miss a cancer diagnosis. Suggestions for reform include higher Medicare reimbursement rates, and allowing health professionals who are not professionals to conduct initial screenings.
The statistics about over-diagnosis are frightening, and call into question the old saying, ‘better safe than sorry.’ However, this does not mean that you should forego a mammogram, merely, that you should, like everything in life, not always take what you see or hear at face value. Furthermore, let’s not forget the importance of prevention; women who have mammograms every two years are 16- 19% less likely to die from breast cancer.
If you believe that you or a family member has been a victim of misdiagnosis, you may contact Greenberg & Bederman for a free medical malpractice consultation about your legal claims. To learn more about medical malpractice issues, please read our frequently asked questions on our medical malpractice page. To learn more about our medical malpractice lawyer, John Sellinger, please read about our firm and go to attorney bios, or watch his medical malpractice video.
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