Misdiagnosis

I’d worry less about the performance of the mammography than about the read of the actual image. The actual mechanics of performing the mammography, while important, are less important than having a well-qualified radiologist. A good radiologist will know both whether the mammography was set up correctly in the first place just by looking at the image (and will re-order another one if not), and whether it’s being read and interpreted correctly. I’d worry less about the performance of the mammography than about the read of the actual image. The actual mechanics of performing the mammography, while important, are less important than having a well-qualified radiologist. A good radiologist will know both whether the mammography was set up correctly in the first place just by looking at the image (and will re-order another one if not), and whether it’s being read and interpreted correctly.

This is REALLY, REALLY, scary....thank you for the great response....how do we change things????? This has happened to me in a way...diagnosed with stage 1, when it was really stage 4...operation although had only gone to my bones. I am trying to find out if I should have even had the masectomy?!!! I do think we have to be careful, and make sure the patient isn't blamed...there is NO way that someone in this situation wouldn't believe or for that matter WANT to believe that it is not as bad as the dr. is making it out to be. (Especially if they are the chief of surgery at a very, very prominent hospital). My question is, and I will be asking it further: Why aren't patients seen by an oncologist first...prior to a surgeon????? My oncologist was the only one who picked up on my back pain...Also surgeons need to have questionairres asking patients about how they feel etc, back pain, etc.!!!!!! Why isn't this monitored by an overall board??????????????????????
According to the CDC, breast cancer is now the most common cancer among women in the United States and it’s also one of the leading causes of cancer death among women of all races and Hispanic origin populations.

To put the number of misdiagnosed cases into perspective, I think it’s important to note that The American Cancer Society says about 230,480 new cases of invasive breast cancer will be diagnosed in women in 2011, about 57,650 new cases of carcinoma in situ (CIS) will be diagnosed (non-invasive/the earliest form of breast cancer), and about 39,520 women will die from breast cancer.

The Journal of Clinical Oncology has reported on some types of cancer misdiagnosis rates (not necessarily solely breast cancer) being as high as 44 percent, and we also see cases where the patient might have breast cancer but the stage was incorrectly diagnosed, which of course could affect outcome, correct treatment, and success rate of care.

Breast cancer misdiagnosis, in particular, is a growing problem, according to a recent study published in the Journal of the National Cancer Institute. While physicians who specialize in mammography maintained an error rate of only about 3 percent, other physicians lacking the correct specialization failed to identify breast cancer 71 percent of the time.

Last year (7/19/10), The New York Times ran an interesting piece reporting on how diagnosing the earliest stage of breast cancer can be surprisingly difficult, prone to both outright error and case-by-case disagreement over whether a cluster of cells is benign or malignant. The piece reported how up to 17 percent of D.C.I.S. (ductal carcinoma in situ) cases “identified by a commonly used needle biopsy may be misdiagnosed.” http://tinyurl.com/3kmt3hb

According to another report 'Diagnostic Errors – The Next Frontier for Patient Safety,” diagnoses that are delayed, wrong or missed entirely, result in 40,000 to 80,000 U.S. hospital deaths annually. About 5 percent of autopsies find clinically significant conditions that were missed and, if treated, could have resulted in the patient surviving the hospital stay.

Last year, we addressed nearly 10,000 new cases. Of those, approximately 1/3 were cancer or cancer-related. We’re tackling a record number of cancer cases again this year, including numerous cases that were initially misdiagnosed. But the harsh reality is that on average 20 percent of the cases we see initially have received the wrong diagnosis, while 60 percent of cases require corrected treatment.

There are a number of reasons for such a high rate of misdiagnosis. Ironically, today we have the most medical knowledge, technology and treatment options than at any other time in history, and yet it’s harder than ever to get people the right care. Studies show that errors happen because doctors are pressed for time and we believe the “revolving door” dynamic in the medical world, where doctors are spending 10-15 minutes or less with each patient, is to blame. Doctors see up to 30 patients a day, 150 a week, 600 each month, and thousands each year. Just think about that - and what it means in terms of the care a patient gets.

Human error is, of course,a factor in misdiagnosis as well. Some health professionals fail to pick up on the early warning signs of a condition, or their lack of expertise or experience in a complicated sub-specialty area – despite their best intentions – may mean they fail to detect a suspicious lump during a routine breast examination. Or perhaps they fail to order the appropriate tests (CT scans, MRI, ultrasound scan or biopsy), or misread the results of the pathology tests, which happens more often than people realize. Sometimes it just boils down to doctors not asking questions that are “off the grid,” and really taking the time to listen to their patient, and get into the ins and outs of the patient’s medical history.

But in today’s crowded climate, the patient is responsible too, in terms of empowering themselves to be the key guardian of their own care and well being. Have they taken the time to assemble and know their own family medical history? Have they shared this information with their doctors – and reminded them of it repeatedly? This is not to shift any blame on the patient, of course; rather, it’s to make the point that by taking some relatively easy, direct steps, you have the power to improve your own health outcomes.

Unfortunately, we see cases like these all too often. Pathology reports can be misread and frequently are, and that alone colors everything in terms of getting the right diagnosis and the right treatment.

Two particular examples come to mind. A recent patient was told by doctors she had a recurrence of the cervical cancer she’d had before and that this time it had spread to her colon. But that diagnosis was wrong; she actually now had colon cancer, and had received the WRONG treatment all that time. Doctors – even doctors from some of the most sophisticated hospitals in the world – can sometimes miss things like this; even things that make us shake our heads when we read about it.

In another case, a patient thought the lump on her throat was a goiter, and had many tests including a biopsy that came back normal. After months of treatment, the lump grew worse and her doctors recommended she just “keep an eye on it.” She came to us for a consultation with our team and experts, who re-tested the tissue from her original biopsy and determined that her biopsy was not normal. We recommended immediate removal of her thyroid, and tests on her removed thyroid showed that she did, in fact, have cancer. Fortunately, it was caught in time. Unfortunately, we see cases like these all too often. Pathology reports can be misread and frequently are, and that alone colors everything in terms of getting the right diagnosis and the right treatment.

Two particular examples come to mind. A recent patient was told by doctors she had a recurrence of the cervical cancer she’d had before and that this time it had spread to her colon. But that diagnosis was wrong; she actually now had colon cancer, and had received the WRONG treatment all that time. Doctors – even doctors from some of the most sophisticated hospitals in the world – can sometimes miss things like this; even things that make us shake our heads when we read about it.

In another case, a patient thought the lump on her throat was a goiter, and had many tests including a biopsy that came back normal. After months of treatment, the lump grew worse and her doctors recommended she just “keep an eye on it.” She came to us for a consultation with our team and experts, who re-tested the tissue from her original biopsy and determined that her biopsy was not normal. We recommended immediate removal of her thyroid, and tests on her removed thyroid showed that she did, in fact, have cancer. Fortunately, it was caught in time.