Failure to properly interpret a screening mammogram

Presentation and physician action

A 42-year-old patient was referred by her gynecologist to a mammography center for a screening mammogram. The patient did not report any problems with her breasts. She provided the screening center with her medical history, including a family history of breast cancer. Her mother, two aunts, and grandmother all had breast cancer.

At the time of this mammogram, the patient’s two previous mammo­gram films were available. The radiologist, the defendant in this case, interpreted the mammogram as negative for evidence of malignancy.

Seven months later, the patient returned to her gynecologist com­plaining of a knot in her left breast. She detected this lump a week before the visit. The gynecologist attempted to aspirate the lump, but no fluid was obtained. He referred the patient back to the mammography center for a diagnostic mammogram and sonogram.

The defendant radiologist reviewed the diagnostic mammogram and sonogram. He believed the mass, visible on the mammogram, was suspicious for malignancy. He measured it at approximately 1. 5 cm in diameter and recommended a surgical consultation.

During this visit to the mammogram center, the patient reported that a staff member “in a white coat” informed her that the radiologist would have found the lump in her breast on the earlier mammogram if he had looked for it. This state­ment was made as the staff member reviewed her films. The patient was unaware of the staff person’s name.

The patient next came to a general surgeon, who performed a needle biopsy. The biopsy showed malignant cells consistent with mammary duct cell carcinoma. The surgeon told the patient that he did not want to offer an opinion as to why the radiolo­gist did not detect the lump on the earlier mammogram. The patient was quite curi­ous and concerned that the condition had gone undetected.

The patient was admitted to the hospital where the surgeon performed a left exci­sional breast biopsy, a left breast lumpectomy, and axillary lymph node dissection. Clear margins were established around the tumor during surgery. The pathologist staged the patient’s cancer at stage II A. Over the next two years, the patient com­pleted chemotherapy, radiation therapy, and was started on hormonal therapy. She has remained free of cancer.

Allegations

In her suit against the radiologist, the patient alleged that he negligently interpreted the screening mammogram films. As a result of this alleged seven-month delay, the plaintiffs claimed the cancer progressed to a more advanced stage, required more ex­tensive treatment than would otherwise have been necessary, and that the patient’s prognosis worsened.

Legal implications

The plaintiffs obtained experts supportive of their allegations, mainly that the mass was visible on the patient’s earlier mammogram and was missed by the radiologist.

Defense experts supported the defendant radiologist’s interpretation of the mammogram. These reviewers, including one for the plaintiff, also stated that the patient would have received the same treatment — surgery, chemo­therapy, radiation, hormone therapy — if the cancer had been detected in the earlier mam­mogram. The experts also hotly debated whether or not the cancer progressed to a more advanced stage during the seven-month period between mammograms.

Disposition

This case was settled on behalf of the radiologist.
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