Legally Speaking: The undiagnosed breast mass

April 1, 2007

Breast masses are common findings during pregnancy and often difficult to accurately diagnose. That difficulty combined with the false sense of security that a negative ultrasound might impart, can occasionally lull a physician into downplaying what may be a very serious condition.

Breast masses are common findings during pregnancy and often difficult to accurately diagnose. That difficulty, combined with the false sense of security that a negative ultrasound might impart, can occasionally lull a physician into downplaying what may be a very serious condition.

THE FACTS

The then 32-year-old patient, gravida III, para II, had been treated by the defendant obstetrician/gynecologist for over 6 years when she presented for prenatal care in 2003. She had a prior history of "congested" breasts but no palpable tumors. During the pregnancy in question, she presented to the defendant physician monthly through June 2003, at which time, at 35 weeks' gestation, she found a lump in her left breast upon self-examination. Her EDC was August 1, 2003.

TWO WEEKS LATER, the patient returned with the sonogram report. The defendant physician's record reflects that the patient was referred to a breast surgeon for evaluation; however, that line appears in lighter ink than the rest of the note. She returned 1 week later at 39 weeks, and there's no indication that a breast examination was performed, nor that the patient made any additional complaints. She presented to the Hospital Center 3 days thereafter, where she underwent an uncomplicated labor and delivery. No indication of, nor any reference to, the breast mass is made in the hospital records.

THE PATIENT DID NOT RETURN for her first postpartum visit until October, at which time the defendant physician prescribed oral contraceptives and, once again, indicated the patient was to see the breast surgeon for evaluation of a possible adenoma. Nowhere in his note does he indicate physical examination was performed, nor does he document the size, shape, or mobility of the mass.

IN FEBRUARY 2004, the patient finally saw the breast surgeon, whose records indicate that she was referred by the defendant ob/gyn for a lump that was discovered at 7 months' gestation. The breast surgeon describes the mass as "huge, the size of a grapefruit," and referred the patient for both mammogram and sonogram, discontinuing the oral contraceptives. The following day, the patient returned to the co-defendant radiologic facility where the U/S and mammogram findings were highly suggestive of malignancy and biopsy was recommended. Three weeks later, the breast surgeon performed an incisional biopsy, revealing an infiltrating 7-cm lobular carcinoma.

WITHIN 5 MONTHS thereafter, the patient had undergone lumpectomy, followed by mastectomy and then chemotherapy. The patient had positive axillary lymph nodes and distant metastases to her liver and bone. By November 2004, the cancer had metastasized to her brain, and she died in March 2005.

• ALLEGATIONS

The patient asserted that the defendant ob/gyn failed to recommend mammography in addition to U/S, despite a suspicious mass and suspicious findings on U/S. The patient alleged that he also failed to timely refer her for evaluation by a breast surgeon, and that the entries made in his chart to the contrary were falsified and made well after the fact, in anticipation of litigation. As a result, it was alleged that the patient's prognosis significantly worsened, her cancer was allowed to grow and ultimately metastasize, resulting in her death.

ADDITIONALLY, the patient made allegations as to the radiology group and the radiologist who interpreted the July 2003 U/S. The patient claimed that the ultrasounds were improperly interpreted as benign, or fibroadenoma, and that the radiologist failed to recommend or perform a mammogram, or spot compression or magnification views of the breast, despite suspicious, irregular margins on a solid mass.