Medico-legal aspects of delay in breast cancer diagnosis: the surgeon's perspective
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KeywordsBreast Cancer Consultant Breast Breast Cancer Diagnosis Junior Doctor Breast Clinic
Delay in the diagnosis of breast cancer is a frequent cause of patients seeking redress through the Courts. Patients are naturally fearful that the delay has reduced their survival. If they feel that their original assessment was in some way casual or superficial, they are often angry.
In the clinic, surgeons have to decide whether a patient has a true lump or not. This is often difficult, and particularly so for trainees. Nevertheless, the surgeon or breast physician must discipline themselves to formally characterise a symptomatic breast abnormality. This should be done by using the standard breast industry classification of 1–5. In this situation, P for palpability precedes the number.
Surgeons will be assisted by their radiologists, who are able to offer a very high level of imaging support.
The problem that arises is when a surgeon or clinician identifies a lump and the radiologist is unable to identify the lump at imaging. It should be remembered that approximately 15% of breast cancers are mammographically occult.
In a recent case, a woman had an 8 cm lump in her breast. The radiologist reports a normal mammogram. Over the next 2 years five different junior doctors observe this lump. Finally, the patient sought a second opinion for her 8 cm Grade I cancer. Why did this occur?
The radiologist was a consultant, the requesting clinician was a (locum) junior. There is a natural tendency to rely on technology, which is usually better than a clinical examination – but not always.
Consultant breast radiologists can appear intimidating to junior doctors. If that junior doctor is working in a poorly organised surgical breast clinic, then there is a potential for mistakes to occur.
The solution is to have the diagnostic process in your breast unit so organised that risks such as these are reduced to a minimum.