About 20 years ago, a woman (at that time in her 50s) was diagnosed with a tumor in her left breast. She underwent chemotherapy and eventually a mastectomy. Since then, she had follow ups once a year with an oncologist to make sure that the cancer is not back. She saw her oncologist on 12/15/2017, 11/15/2018, 11/18/2019 and 11/19/2020. This oncologist, which saw her at a hospital, sent her to do a mammogram on 10/3/2018, which showed no evidence of malignancy and another mammogram on 10/2020 which showed BIRADS-2.
Around 10/27/2020, she fell and broke several ribs, she went to the ER and was discharged without any complications. A week later she felt sharp pain in her chest/abdomen and due to this pain, on 11/22/2020, just few days after she saw her regular oncologist, she went to the ER at a different hospital, where she underwent a series of tests, including CT scans, x-rays and blood tests. The tests showed that she had multiple tumors, including in the lungs, liver, spine, right breast and bones.
She started to see a new oncologist and was diagnosed with stage IV cancer.
I would like to ask the following questions:
1. If we disregard the yearly follow up that the potential client had with her oncologist on 11/19/2020, and focus on the 11/18/2019 follow up, is it possible that on 11/18/2019 she did not have cancer at all and between 11/18/2019 and November 2020, she developed stage IV cancer?
2. How long would it usually take to develop a stage IV cancer? Or what would be the average time to develop it
Files:
No questions yet!
Do you believe there might have been medical error?
She had a mammogram on 10/2020. it was BI-RADS 2which is a benign category in breast imaging reporting and data systems. There is unlikely to have missed it if mammogram done in 2019. we also do not do restaging scans for breast cancer other than a good physical exam.
Do you believe there might have been causation (i.e. the medical error resulted in an injury)?
Breast cancer, hormone-positive can come back anytime. guidelines do not recommend CT scans. a screening mammogram is the best option. she had a BIRADs-2 in 2020.
What makes you a good expert for this case?
I have done defense work and have been deposed on trial on 4 defense trials.
How often do you encounter cases similar to this one in your practice?
not routinely. we do not see this commonly for breast cancer
Do you believe there might have been medical error?
A patient who has a history of breast cancer could easily have recurrence in their lifetime, even if the primary tumor was 20 years ago. The fact that a mammogram was negative Oct 2018 does not concern me. The fact that the patient had a mammogram on October 2020 which showed BIRADS-2 suggests a *possible* local issue. But, Oct 27th, the patient has metastatic disease. It is not clear that the source of metastatic disease (Stage IV cancer) came from the local breast recurrence, since no report of a biopsy was made.
Do you believe there might have been causation (i.e. the medical error resulted in an injury)?
It is very possible that the patient had no cancer at all on Nov 18 2019 and then had stage IV (metastatic) disease on November 2020. The source of metastatic disease is not even necessarily from the breast lesion seen in November 2020 on the mammogram. Is the metastatic disease even breast cancer? We need a biopsy of the metastatic disease to confirm. The only potential source of error would be if the mammogram in October 2019 was interpreted incorrectly and there was an actual lesion that was never investigated.
What makes you a good expert for this case?
I am a medical oncologist, but not an expert in breast cancer.
How often do you encounter cases similar to this one in your practice?
I am not seeing patients with breast cancer.
Do you believe there might have been medical error?
We have a mammogram of the non-resected breast showed Birads 2 which is not premalignant. Unlikely to be a stage IV malignancy from prior breast cancer after 20 years. Routine aggressive follow up & imaging is not warranted after 20 years. There was no symptomatology leading to imaging for this patient’s unfortunate circumstance until she broke ribs after a fall.
Do you believe there might have been causation (i.e. the medical error resulted in an injury)?
Many stage IV malignancies occur while the patient is asymptomatic and therefore would be unlikely to be picked up by routine exam.
What makes you a good expert for this case?
37 years experience in medical oncology taking care of a wide variety of malignancies
How often do you encounter cases similar to this one in your practice?
Three or four times a year this type of patient arises unexpectedly with stage IV Cancer in an asymptomatic state
Want to open a case or submit response?
Comments are accepted only from Medical Oncology experts.