Breast Cancer Overview: Misdiagnosis and Delayed Diagnosis

What is breast cancer and its symptoms?

Breast cancer is a disease in which cells in the breast grow uncontrollably. The cells usually form a tumor that can be seen in an x-ray or felt as a lump. Breast cancer is the second most common cancer diagnosed in the United States. Breast cancer can occur in both men and women, however it is much more common in women. About 1 in 8 women in the U.S. will develop breast cancer during their life. For men, the lifetime risk of breast cancer is 1 in 833

 

It is noteworthy that tumors can be either benign (not cancerous) or malignant (cancerous). Benign tumors are not considered to be cancerous because the cells have a normal appearance and are not invading any nearby tissues or spreading abnormally. Conversely, malignant tumors are cancerous. When left unchecked, the cells can spread outside of the initial tumor and to other parts of the body, which is known as metastatic breast cancer (also known as stage IV breast cancer).

Signs and symptoms of breast cancer include:

  • A lump in the breast or underarm that feels different from surrounding areas.

  • Thickening or swelling of part of the breast.

  • Dimpling, irritation, or changes of breast skin.

  • A newly inverted nipple.

  • Peeling, flaking, or crusting skin in the nipple area or breast skin.

  • Pain in any area of the breast.

  • Change in breast color.

  • Increase in breast size or shape over a short period of time.

  • Nipple discharge other than breast milk.

Breast cancer can be caused by a genetic abnormality, or a mutation in genetic material. Statistics show that only about 5-10% of cancers are hereditary. 85-90% of breast cancers are due to genetic abnormalities from aging. Breast cancer can start to form in different parts of the breast. Most breast cancers begin in the breast’s milk ducts, while others begin in the lobules (glands that make the breast milk).  A small number of cancers start in the tissues of the breast. 

The most common types of breast cancer are:

  • Ductal carcinoma. The cancer cells start outside the ducts into other parts of the breast tissue.

  • Lobular carcinoma. The cancer cells spread from the lobules into other parts of the breast tissue. 

Other less common types of breast cancer include:

  • Medullary

  • Mucinous

  • Papillary breast cancer

  • Inflammatory breast cancer

How is breast cancer diagnosed?

Before you even show up to your doctor with suspected breast cancer symptoms, there are many ways to test for breast cancer. Breast cancer screening refers to testing for the presence of breast cancer in a patient before any symptoms of breast cancer are present. Screening methods provide opportunities to detect breast cancer early. It is beneficial to identify breast cancer early because, like with most cancers, when breast cancer is detected at an earlier stage, it is more controlled and therefore easier to treat. Breast cancer screening methods are similar methods used by doctors to identify and diagnose breast cancer. 

 

After you or your doctor notices a breast abnormality, your doctor will often send you for follow-up testing used to diagnose breast cancer. Diagnostic tests are used to confirm or deny the presence of breast cancer.  If breast cancer is present, your doctor will use further testing to gain more information about the cancer in order to correctly stage the cancer and to set a course of treatment.  Staging breast cancer refers to determining how much the cancer has spread in a patient’s body and staging further influences treatment courses available to patients. These methods of breast cancer diagnostic tests include but are not limited to the following:

 

  • Mammograms. A mammogram is a breast x-ray.  Women aged 50 and older are recommended to get mammograms every two years, as they are at an average risk of developing breast cancer, and mammograms are an efficient tool to detect early stages of breast cancer. A doctor orders a diagnostic mammogram when there is a specific area that a doctor would like to see in more detail.  Diagnostic mammograms provide a more detailed x-ray of the breast and can lead to a more efficient diagnosis of breast cancer.

  • Breast Magnetic Resonance Imaging (MRI). Breast MRI’s take detailed photos of the inside of the breast. 

  • Breast Ultrasound.  Ultrasounds use sound waves to collect pictures, or sonograms, of the inside of a breast.  Breast ultrasounds are also often used to perform needle biopsies of suspicious masses within breasts. 

  • Biopsies. Biopsies remove tissue or fluid from the inside of the breast to later be examined under a microscope and to aid in further testing and diagnosing.  Biopsies can be performed differently, for example there are:

    • Fine-needle aspiration biopsies. This type of biopsy is used for lumps or abnormal-appearing breast tissue that is located just beneath the skin.  During this procedure a small needle is placed into the abnormal tissue and this needle removes a piece that will later be tested and observed by clinicians. 

    • Core biopsies. Similar to a fine-needle aspiration biopsy, during core biopsies, a needle is placed below the skin to remove a piece of abnormal breast tissue for testing.  The main difference between core and fine-needle aspiration biopsies is that fine-needle biopsies use smaller needles to perform their biopsies.

    • Open biopsies. Open biopsies are surgical procedures that open up the breast to expose and remove the abnormal breast tissue.  The tissue is then examined under a microscope. 

After a breast cancer diagnosis, monitoring tests used during and after treatment to observe growth, reaction to treatment, and scan for any recurrence of cancer.  Monitoring tests include but are not limited to:

  • Positron Emission Tomography (PET) scans. PET scans are used not to diagnose breast cancer, but to determine whether or not breast cancer has spread to other areas of the body (known as metastasis).  PET scans are also used to determine whether metastatic breast cancer is responsive to treatment.

  • Computerized Tomography (CT) scans. CT scans are not used to diagnose breast cancer, but to determine whether the breast cancer has spread to the chest cavity or any other major organs.

  • Blood Cell Counts. Blood cell counts are regularly ordered throughout a patient's treatment plan to assess white blood cell, red blood cell, and platelet levels.  These three levels show treating doctors a patient’s immune response capabilities, oxygen-carrying capacity, and blood clotting levels, respectively, all vital bodily processes that must be kept in check during treatment.  Doctors adjust medication levels or treatment plans depending on blood cell count results.

  • Regularly-scheduled Mammograms. As discussed above, routine mammograms can help detect relapse or new cancer involvement in the opposite breast.

Misdiagnosis

Misdiagnosis can also be a product of medical malpractice. Breast cancer misdiagnosis can take many forms. This most commonly happens when a doctor wrongly diagnoses breast cancer as benign breast conditions, such as: 

  • Blocked milk ducts

  • Cysts

  • Fibrocystic breast disease

  • Fibroadenomas 

  • Fat necrosis 

  • Lipomas 

  • Pseudoangiomatous stromal hyperplasia

Another form of breast cancer misdiagnosis is when a doctor wrongly diagnoses a patient with non-invasive cancer. Non-invasive breast cancers stay in the breast ducts and do not spread to healthy tissues. Patients with non-invasive breast cancer require different treatments and have a higher survival rate than those with invasive breast cancer. When a doctor misdiagnoses invasive breast cancer as non-invasive breast cancer, the patient may lose valuable time needed to treat the invasive cancer in its earliest stages. 

Failure to diagnose is also a form of breast cancer misdiagnosis. This occurs when doctors should have detected breast cancer based on symptoms, common age-based tests, or readily available screening methods. Examples of failure to diagnose include not performing a test that would have detected breast cancer, misreading test results or missing certain signs that should lead to an accurate diagnosis. 

Finally, a doctor may even misdiagnose a benign breast condition as breast cancer. When this occurs, patients may end up undergoing unnecessary cancer treatment, which is costly and may have severe side effects. 

Delayed Diagnosis  

In certain circumstances, a delayed diagnosis can be considered medical malpractice. A delayed breast cancer diagnosis can cause you to suffer a potentially lifelong disability (e.g. removal of an essential organ such as a kidney, due to metastasized cancer growth that could have been avoided with timely diagnosis) or may even be fatal much like a medical misdiagnosis. For instance, doctors and health-care specialists have been known to misread imaging equipment like mammograms and ultrasounds during routine checkups. This may delay the diagnosis of breast cancer that consequently delays treatment. Additionally, delaying proper treatment for breast cancer, due to a delayed diagnosis can lead you to undergo harsher medical and surgical treatments in an effort to curb the cancer’s growth. Keeping a record of medical files along with all your pathology lab reports is of utmost importance if you would want to pursue a claim of delayed diagnosis against your doctor.

Some common reasons for delayed diagnosis leading to medical malpractice suits:

  • Failure to screen for breast cancer via mammogram and ultrasound.

  • Misreading/misinterpretation of imaging results (e.g. x-rays, PET scans and CT scans)

  • Failing to examine a palpable mass during a breast examination

  • Failing to test (biopsy) a palpable mass during examination.

Facts and Thoughts for Consideration

A recent study analyzed the characteristics of  medical malpractice litigation involving breast cancer in New York state for the past 10 years. Shockingly, the average delay to diagnose breast cancer was significant, totaling 13.4 months. On average, plaintiffs who filed lawsuits against healthcare providers received approximately $2.6 million in verdicts and $1.7 million from settlements. 

Lawsuits for “delayed diagnosis” are challenging because the evidence must demonstrate an oversight or error occurred during the formulation of the diagnosis. Moreover, the oversight/error must have departed from the common standard of care resulting in unwarranted harm. Generally, a health-care professional’s “delayed diagnosis” is often corrected before a patient suffers severe harm and as a result, this may weaken a legal claim. However, an important question to ask is whether another health-care provider with similar training and skill, under the same circumstances, would correctly diagnose the condition and prevent unwarranted harm from the onset. Medical malpractice lawsuits are layered with complexity and you should consult with an experienced attorney who can advise you regarding your legal rights.