Breast cancer is the second leading cause of cancer deaths in women. Every year, more than 40,000 women die in the U.S. from breast cancer. Early detection with routine breast cancer screening followed immediately with appropriate treatment could prevent many of these deaths. A doctor’s failure to recommend routine breast cancer screening to their female patients and to follow up on abnormal test results may constitute medical malpractice.

Screening for breast cancer

Cancer specialists generally recommend that a doctor should order a yearly mammogram and conduct a yearly clinical breast examination on all female patients age 40 or older, even if the patient has no family history of breast cancer and has no symptoms. A doctor should perform a breast examination every 3 years for female patients in their 20s and 30s. If a patient is at moderate (15%-20%) lifetime risk the doctor should discuss the option of adding a yearly MRI as part of the screening process. For patients at high (>20%) lifetime risk, the doctor should add a yearly MRI to the screening process. The lifetime risk is assessed based on such factors as family history, the presence of gene mutations, characteristics of the breast, and personal medical history.

The clinical breast examination determines whether there are any palpable lumps or other abnormality in the breast that could indicate the presence of cancer. The mammogram and MRI use imaging technology to identify changes or masses in the breast that may not detectable from a clinical breast examination. Should an abnormality be found, a biopsy (sampling of breast tissue) is then performed to rule out or confirm the presence of cancer.

The progression of the breast cancer is tracked through stages

Once breast cancer is diagnosed, the cancer’s progression is categorized using a five-level staging system:

• Stage 0 (Also known as Carcinoma In Situ): There are 2 types – (1) Ductal carcinoma in situ (DCIS) which is a noninvasive condition which involves the presence of abnormal cells confined to the lining of the breast duct, and (2) Lobular carcinoma in situ (LCIS) which involves the presence of abnormal cells in the lobules of the breast.
• Stage I: The tumor is less than 2 cm and has not spread outside the breast.
• Stage IIA: Either (1) no tumor is found in the breast but cancer is found in at least one of the axillary lymph nodes (the lymph nodes under the arm), (2) the tumor is 2 cm or smaller and has spread to the axillary lymph nodes, or (3) the tumor is between 2 cm and 5 cm and has not spread to the axillary lymph nodes.
• Stage IIB: Either (1) the tumor is between 2 cm and 5 cm and has spread to the axillary lymph nodes, or (2) the tumor is larger than 5 cm and has not spread to the axillary lymph nodes.
• Stage IIIA:Either (1) no tumor is found in the breast but cancer is found in axillary lymph nodes that are attached to each other or to other structures, or cancer may be found in lymph nodes near the breastbone, (2) the tumor is 2 cm or smaller and the cancer has spread to axillary lymph nodes that are attached to each other or to other structures, or cancer may have spread to lymph nodes near the breastbone, (3) the tumor is larger than 2 centimeters but not larger than 5 centimeters and the cancer has spread to axillary lymph nodes that are attached to each other or to other structures, or the cancer may have spread to lymph nodes near the breastbone, or (4) the tumor is larger than 5 centimeters and the cancer has spread to axillary lymph nodes that may be attached to each other or to other structures, or cancer may have spread to lymph nodes near the breastbone.
• Stage IIIB:The tumor may be any size and the cancer (1) has spread to the chest wall and/or the skin of the breast, or (2) may have spread to axillary lymph nodes that may be attached to each other or to other structures, or cancer may have spread to lymph nodes near the breastbone.
• Stage IIIC:The cancer is operable if it is detected (1) in ten or more axillary lymph nodes, (2) is found in lymph nodes below the collarbone, or (3) is found in axillary lymph nodes and in lymph nodes near the breastbone. The cancer is inoperable if it has spread to the lymph nodes above the collarbone.
• Stage IV: The cancer has spread to other organs in the body, usually the bones, lungs, liver, or brain.

Breast cancer treatment and prognosisCancer specialists associate a statistic called the 5 year survival rate with each stage of the cancer. This statistic reflects, for each stage, the percentage of women who will survive 5 years or more after a diagnosis with that particular stage.

For Stage 0, treatment options include a breast conserving surgery (lumpectomy or partial mastectomy) with sentinel lymph node biopsy or lymph node dissection and radiation therapy, mastectomy (for women at high risk a bilateral prophylactic mastectomy may be an option), and/or hormone therapy (such as Tamoxifen or an aromatase inhibitor). The 5-year survival rate is nearly 100% for Stage 0.

For Stage I, treatment options include a lumpectomy (breast conserving surgery) with sentinel lymph node biopsy or lymph node dissection and radiation, mastectomy, and chemotherapy and/or hormone therapy. The 5-year survival rate is also nearly 100% for Stage 1.

For Stage II, treatment options include breast conserving surgery (a lumpectomy or modified mastectomy) with sentinel lymph node biopsy or lymph node dissection and radiation, mastectomy, and chemotherapy and/or hormone therapy. The 5-year survival rate is 92% for Stage IIA and 81% for Stage IIB.

For Stage IIIA, the treatment options remain the same as for Stage II. The relative 5-year survival rate is 67% for Stage IIIA

For Stages IIIB and IIIC, treatment options vary depending on whether the cancer is operable. Chemotherapy is often the initial treatment in order to attempt to reduce the size of the tumor. If the tumor is operable, then treatment options may include breast conserving surgery (a lumpectomy or modified mastectomy) or mastectomy with sentinel lymph node biopsy or lymph node dissection, radiation, and chemotherapy and/or hormone therapy. If the cancer is inoperable, the 5-year survival rate is 54% for Stage IIIB.

For Stage IV, treatment normally consists of radiation therapy, hormone therapy and/or systemic chemotherapy, Tyrosine kinase inhibitor therapy, radiation therapy, surgery and medications to relieve pain, and clinical trials. The 5-year survival rate drops to approximately 20%.

Failure to screen for breast cancer may constitute medical malpractice

Unfortunately, even though the statistics make it very clear that early detection through breast cancer screening saves lives, there are still doctors who fail to screen female patients for breast cancer. They fail to perform breast examinations and fail to order mammograms. And some doctors ignore abnormal breast examination results and even abnormal mammograms results. By the time the cancer is discovered – often because the patient sees a different doctor who finally conducts a clinical breast examination or orders a mammogram, or the patient starts to feel back pain or other symptoms – the breast cancer has already advanced to a Stage III or even a Stage IV. The prognosis is now much different for this woman than it would have been had the breast cancer been detected early through routine breast cancer screening. As a result of the failure on the part of the doctor to advise a female patient to undergo routine screening, or to follow up on an abnormal mammogram or MRI result, the breast cancer is now much more advanced and the woman has suffered a “loss of chance” of a better recovery. In other words, she now has a reduced chance of surviving the breast cancer.

Contact a Lawyer Today

If you or a family member suffered a delay in the diagnosis of breast cancer due to a doctor’s failure to recommend routine screening or to follow up on abnormal breast examination or mammogram results, you need to contact a lawyer immediately.

This article is for informational purposes only and is not intended to be legal or medical advice. You should not act, or refrain from acting, based upon any information at this web site without seeking professional legal counsel. A competent lawyer with experience in medical malpractice can assist you in determining whether you may have a claim for a delay in the diagnosis of breast cancer due to a failure on the part of the doctor to offer breast cancer screening. There is a time limit in cases like these so do not wait to call.

Surgery. Treatment varies according to the type and stage of cancer, but surgery remains the first choice for most tumors. The majority of operations now are less disfiguring than the radical mastectomy that was standard until the 1970s. Operations for breast cancer are Extended radical mastectomy involves removal of the breast, underarm lymph nodes, and underlying chest muscles. This procedure, rarely performed today, is reserved for women with large tumors that are attached to or have invaded the chest muscle and its connective tissues. If the mammary lymph nodes deep in the chest are involved, they will also be removed. Modified radical mastectomy is the removal of the breast, underarm lymph nodes, and sometimes part of the chest muscle. The amount of tissue removed from the underarm depends on the spread of the tumor. This remains the most common operation for women with invasive breast cancer. Total, or simple, mastectomy is the removal of the entire breast, including its extensions to the armpit and some times near the collarbone. Because the lymph nodes are left intact, radiation therapy usually follows the operation.

Subcutaneous mastectomy involves removing the breast tissue but leaving the skin and nipple intact. A prosthesis is then slipped under the skin to restore normal appearance. This procedure is rarely performed, because it may miss cancer cells and the cosmetic results are often poor. Lumpectomy or partial mastectomy involves removal of the cancerous lump and a surrounding margin of normal tissue. Some of the armpit lymph nodes are also taken out and examined for spread, and the operation is followed by radiation therapy. Preventative, or prophylactic, mastectomy is the removal of a breast to prevent the development of cancer. This operation is done only if a woman has a very high risk of breast cancer and is so worried by the prospect that she cannot live a normal life. Breast reconstruction by a plastic surgeon can sometimes be performed immediately following a mastectomy, but more often it is done after the original incision has healed. If the opposite breast is larger, it may be reduced in size to match the reconstructed one, either at the same time as the reconstruction or in a later operation. In the past, a prosthetic implant filled with silicone gel was the first choice for reconstruction. Because questions have arisen about the long term safety of silicone, many women are now opting for implants filled with a saline solution, or a more extensive procedure in which fatty tissue from the woman’s own buttocks or elsewhere is used to reconstruct a breast.

Radiation Therapy . The purpose of this treatment is to destroy any cancer cells that may have escaped surgical removal. Radiation is routinely administered after a simple mastectomy and a lumpectomy, or if numerous lymph nodes have been affected. It is also prescribed for recurring or inoperable cancer, and to alleviate the pain of advanced cancer. Typically, radiation treatments are begun two or three weeks after the surgery, or after the scar has healed and the woman has regained the use of her arm. Immediate side effects include blistering of the skin and fatigue. Later, the skin exposed to the radiation may darken, thicken, and lack sensitivity if any nerve endings have been damaged. Long term complications may include impaired lung function due to scar tissue, an increased risk of heart disease, and easy fracturing of the ribs. Chemotherapy. Studies indicate that adjuvant chemotherapy greatly increases long term survival, even for women with localized stage I cancer.

Chemotherapy may begin before surgery; however, it is usually started a few weeks afterwards. This treatment is also prescribed for recurrent or inoperable cancers. Chemotherapy appears to be most effective in preventing a recurrence among younger women who have not gone through menopause. The side effects loss of hair, nausea, reduced immunity to infections, mouth sores, fatigue, and bleeding problems are temporary, but still very trying. For this reason, chemotherapy may not be recommended for an older woman, especially if her cancer is localized. Hormone Therapy. Cancer specialists now believe that almost all breast cancer patients can benefit from hormone therapy, even if their tumors are not the type stimulated by estrogen or proges terone. Thmoxifen (Nolvadex), a drug that blocks estrogen, is the treatment of choice. It has fewer side effects than anticancer drugs, although it may cause hot flashes and other menopausal symptoms in younger women. Other, more radical approaches to hormone manipulation include ovarian ablation, a procedure in which the ovaries are either surgically removed or destroyed by chemicals or radiation, and perhaps the removal of other hormone producing glands.

Experimental Treatments

Women with advanced breast cancer may be candidates for experimental therapies such as hyperthermia, in which very high fevers are induced to kill cancer cells, photodynamic therapy, which uses a light sensitive anticancer drug; and bone marrow transplantation, in which the woman’s bone marrow is destroyed by drugs and then replaced with healthy marrow to bolster the body’s ability to fight the cancer.