Leading Breast Cancer Experts Discuss Delayed Surgical Intervention for Metastatic Carcinoma

Case Overview

This case involves a middle-aged female who presented to a breast surgeon with an existing diagnosis of breast cancer. At the time of presentation, the physician recommended a treatment plan of chemotherapy followed by surgery. The patient was offered and agreed to total mastectomies of both breasts, to be undertaken after she completed chemotherapy. After the patient’s regimen of chemotherapy was completed, imaging reported an excellent result and the patient underwent surgery. Following the surgery, the Defendant physician informed the patient that a full biopsy would be done. The biopsy performed revealed metastatic carcinoma involving a number of lymph nodes. The Defendant told the Plaintiff that she did not need additional surgery, citing “recent literature” that claimed identical survival rates for patients who received only external beam radiation compared with those who received both surgery and radiation. Eventually, the patient received a second opinion and was told that she needed to have surgery immediately.

Questions to the Hematology expert and their responses

Do you routinely treat patients with the presentation described above?

The issues in this case are mostly controversial. A repeat axillary node biopsy after a sentinel node was questionable and should not have been done, but an axillary dissection should have been carried out, but accuracy of a biopsy in such situations is low to poor.

Could this patient's lymph nodes have been removed in a more timely manner rather than relying solely upon radiation therapy?

Whether radiation should be used or axillary dissection is in a current clinical trial, so it is not known if the patient's lymph nodes could have been removed in a more timely manner.

Is it likely that the delay would impact this patients prognosis?

The wait for the biopsy may have accounted for additional delay.

About the expert

This highly qualified, board certified, extremely well published expert earned his bachelor's degree from Yeshiva University and his medical degree from the State University of New York Downstate Medical College. This was followed by a residency in internal medicine at the New York Presbyterian Lower Manhattan Hospital and at Hahnemann University Medical Center. This expert then completed his formal medical education by pursuing a fellowship in Hematology and Oncology at the Long Island Jewish Hillside Hospital Medical Center. This expert has earned numerous awards for his contributions as a physician. This expert is extremely well published, having authored 28 Peer-reviewed Journal Articles, 10 Abstracts and 16 reviews. This expert's mastery of research has allowed him to serve as reviewer and editor for numerous leading medical journals. This expert previously held numerous positions, serving as Director of the Cancer Center of Generations Manhattan, Chief of Hematology and Oncology and associate director of the cancer center at Lincoln Medical Center, Co-Director of the Division of Medical Oncology and Hematology at Brookdale University Hospital, Associate Professor of Clinical Medicine at Cornell University and as Associate Professor of Medicine at the University of Medicine and Dentistry of New Jersey. This expert currently serves as Associate Attending at a regional hospital and on the Medical advisory board for a pharmaceutical company.