This case involves a young woman with a family history of breast cancer who was referred to a medical center for evaluation of a lump in her right breast. At the facility, she underwent a mammogram and ultrasound, both of which were read as normal, and she was told that she was cancer free. After the examination, she was released without follow up. Some time later, she was seen by another physician, who ordered scans after feeling lumps in the same breast. Her treating oncologist later informed her that the original ultrasound was inappropriately administered, and had been performed in the wrong local region. By the time of the second scans the tumor had doubled in size. She was diagnosed with an advanced and aggressive form of cancer, and eventually had a double mastectomy.
Question(s) For Expert Witness
- Do you routinely treat patients similar to the one described in this case?
- Have you ever had a patient develop the outcome described in the case?
- Can a delay in diagnosis of this amount of time impact a patient's course of treatment?
Expert Witness Response E-000029
First, the standard teaching is that a palpable mass requires a biopsy irrespective of the results or ultrasound and mammography. Second, based on the rapid growth, I would estimate that the stage was I at initial presentation and now is stage II. Prognosis, however, is not greatly different between these stages: 100% versus around 90% survival respectively. It is possible that the prognosis of stage II in this case was actually worse, since it appears to have been rapidly growing, however I would need pathology report to assess that. In stage I, chemotherapy is usually not required, so the need for chemotherapy is one of the possible issues here. I don’t know why a bilateral rather than unilateral mastectomy was performed, and this may be another consequence of the delayed diagnosis. In my practice I routinely treat patients similar to the one described in this case and I have special experience in breast cancer – having published and done research in this area.