Need Breast Cancer Oncology Review:
On June 10, 2022, 41-year-old female patient underwent a diagnostic mammogram for breast cancer screening, which was interpreted as showing no mammographic evidence of malignancy in either breast, and routine annual mammographic follow-up was recommended. In July 2023, the patient developed new symptoms, including right breast pain and a palpable lump, prompting further evaluation with mammogram/tomosynthesis and a targeted ultrasound on July 19, 2023. Imaging of the right breast identified a predominantly hypoechoic lesion corresponding to the palpable abnormality, which was documented as probably benign and thought to represent a fibroadenoma or focal fibrocystic change, with a recommendation for six-month follow-up imaging rather than immediate additional workup. No malignancy was identified in the left breast. Despite this assessment, the patient continued to experience a persistent right breast lump with tenderness and worsening back pain through early December 2023. In December 2023, the patient presented to the emergency department, where diagnostic imaging revealed findings consistent with metastatic disease, leading to referral for oncology evaluation. On December 11, 2023, further imaging and diagnostic testing confirmed bone metastases and established a diagnosis of Stage IV metastatic invasive ductal carcinoma of the right breast, hormone receptor positive and HER2 negative. Pathology consistent with invasive ductal carcinoma ER positive greater than 90-100%, PR positive greater than 90%, HER2 Neu-0, Ki-67 30%.
Files:
No questions yet!
Do you believe there might have been medical error?
PATIENT HAD A breast lesion which should have been investigated with ultrasound and a biopsy.
Do you believe there might have been causation (i.e. the medical error resulted in an injury)?
this lead to a stage IV disease. Even though it is the HR receptor-positive patients who do well, she will need to be on lifelong treatment, dealing with side effects.
What makes you a good expert for this case?
I have testified in court but all on defense side
How often do you encounter cases similar to this one in your practice?
This is not uncommon. we do see dealy in diagnosis
Do you believe there might have been medical error?
Given that patient had palpable mass in July scan which was not biopsies and presumed to be benign. If in Dec, there was no other finding in the breast, it is likely that the right breast mass metastasized to the bone. Generally any newly palpable mass should have diagnostic mammogram, ultrasound and biopsy.
Do you believe there might have been causation (i.e. the medical error resulted in an injury)?
If the mass patient felt in July ultimately metastasized to bone, it is likely causation. Only question will be- was there already bone met when she felt a mass in June (which we will never be able to answer). Also, if there any other area in breast which metastasized - which can be answered if there was a repeat mammogram in Dec.
What makes you a good expert for this case?
Medical oncologist with over 10 years of experience and 50% breast cancer practice
How often do you encounter cases similar to this one in your practice?
50% of my practice is breast cancer.
Do you believe there might have been medical error?
The only possible source of error I could see could be if the mammogram that showed benign findings was misread and instead there was a visible breast cancer. But I don't have evidence of this in the current description of this case.
Do you believe there might have been causation (i.e. the medical error resulted in an injury)?
Same as above, depends on what the mammogram showed.
What makes you a good expert for this case?
I am a medical oncologist and an expert in breast cancer. I am Associate Professor of Medicine at Harvard Medical School, one of the best medical schools in the world. I work as a breast cancer medical oncologist at Dana-Farber Cancer Institute, one of the leading cancer centers in the world. I have multiple publications and scientific presentations in the field of breast cancer. I have significant experience as an expert medical reviewer, having reviewed multiple cases both for plaintiff and defendant.
How often do you encounter cases similar to this one in your practice?
Multiple times per week, I see around 30 breast cancer patients per week
Want to open a case or submit response?
Comments are accepted only from Medical Oncology experts.