This case takes place in Arizona and involves a forty-three-year-old female patient who originally presented to her primary care physician in 2005 with complaints of a newly discovered breast lump that was associated with pain in the area of the breast. Her physician advised her that it was likely not cancerous because it was painful and most likely a cystic formation. She underwent a mammography and biopsy that was consistent with a benign cyst. In 2011 the patient felt a new lump in the right breast that was in the area of the previous cyst that was removed. The mass continued to grow and an ultrasound performed in July of 2012 revealed the presence of a suspicious lesion. A biopsy of this new mass was consistent with a breast carcinoma. The patient then had a PET scan that showed a suspicious pelvic lesion and it was at that point she was offered chemotherapy which consisted of eight cycles of treatment with Adriamycin, Cyclophosphamide and Taxotere. The patient underwent a double mastectomy after completing the chemotherapy regimen, with no apparent lymph node evaluation done at this time. It was later determined after further investigation that the patient was positive for a BRCA mutation.
Question(s) For Expert Witness
- Should the patient’s breast carcinoma have been discovered earlier? Should this patient have been followed more closely to prevent the development of her disease? Should this patient have been sent for BRCA testing sooner to plan for a targeted treatment regimen?
Expert Witness Response E-006273
This is certainly one of those unfortunate cases where a previously normal work-up may have delayed a diagnosis of a new problem, in this case breast cancer. From the information provided, it is unclear if there were any efforts made in 2011 to diagnose the new breast mass, or if the patient delayed an evaluation until the mass began to grow. If medical attention for the mass was sought in 2011, it would have been standard of care to perform imaging such as mammogram with or without ultrasound. Any abnormalities on mammogram would have triggered some type of biopsy, which would hopefully have identified an underlying malignancy. If the imaging were negative for suspected malignancy, more frequent follow-up with breast exams and repeated imaging would have been helpful to ensure that a malignancy was not developing.