ABSTRACT
According to the Physician Insurers Association of America (PIAA), the most expensive and common medicolegal claim against physicians related to errors of diagnosis in malignant diseases is delay in the diagnosis of breast cancer. Although just 40% of all breast cancers occur in women younger than 50 years old, 60% of the claims of a delayed diagnosis of breast cancer arise in this group. Unimpressive findings on a physical exam (54.7%) topped the list of reasons for physician-related causes of delay in diagnosing breast cancer. Other factors in the PIAA survey included negative mammogram report (35.7%), failure to do an appropriate biopsy to evaluate a suspicious mass (26.8%), no suspicious findings discovered on repeat exam (24.5%), delay in requesting a consult or in referring a patient for further evaluation (18.2%), record-keeping errors (16.0%), inadequate physician-to-physician communication (13.8%), physician distraction by patient's other health problems (12.3%), mammogram misread (8.8%), and poor physical examination done by physician (5.9%). Three elements are vital to an effective breast-screening program: a comprehensive breast history, a thorough breast examination, and a clear record of findings and follow-up.
ABSTRACT
More than 1 million American women have undergone augmentation mammoplasty; 100,000 (10%) will develop or already have developed breast cancer. Between March 1981 and August 1986, 20 patients with previous augmentation mammoplasty were treated for breast carcinoma. All patients had unilateral infiltrating carcinomas and presented with a palpable mass. None of the cancers were occult (discovered mammographically). Thirteen patients (65%) had metastases to axillary lymph nodes. During the same period, 733 nonaugmented patients with breast cancer were treated: 207 (28%) had involved axillary nodes, 194 (26%) had in situ lesions, and 154 cancers (21%) were occult. Augmentation mammoplasty with sillicone-gel-filled implants reduces the ability of mammography, our best diagnostic tool, to visualize breast parenchyma. When compared with our own nonaugmented breast cancer population, augmented patients with breast cancer presented with more advanced disease; they had a higher percentage of invasive lesions and positive axillary nodes, resulting in a worsened prognosis.
