Oncology Expert Witness Comments on Delayed Diagnosis of Breast Cancer

Case Overview

This case involves a young woman with a family history of breast cancer who was referred to a medical center for evaluation of a lump in her right breast. At the facility, she underwent a mammogram and ultrasound, both of which were read as normal, and she was told that she was cancer free. After the examination, she was released without follow up. Some time later, she was seen by another physician, who ordered scans after feeling lumps in the same breast. Her treating oncologist later informed her that the original ultrasound was inappropriately administered, and had been performed in the wrong local region. By the time of the second scans the tumor had doubled in size. She was diagnosed with an advanced and aggressive form of cancer, and eventually had a double mastectomy.

Questions to the Hematology expert and their responses

Do you routinely treat patients similar to the one described in this case?

In my practice I routinely treat patients similar to the one described in this case and I have special experience in breast cancer - having published and done research in this area.

Have you ever had a patient develop the outcome described in the case?

First, the standard teaching is that a palpable mass requires a biopsy irrespective of the results or ultrasound and mammography. Second, based on the rapid growth, I would estimate that the stage was I at initial presentation and now is stage II. Prognosis, however, is not greatly different between these stages: 100% versus around 90% survival respectively. It is possible that the prognosis of stage II in this case was actually worse, since it appears to have been rapidly growing, however I would need pathology report to assess that.

Can a delay in diagnosis of this amount of time impact a patient's course of treatment?

It is possible that the prognosis of stage II in this case was actually worse, since it appears to have been rapidly growing. In stage I, chemotherapy is usually not required, so the need for chemotherapy is one of the possible issues here. I don't know why a bilateral rather than unilateral mastectomy was performed, and this may be another consequence of the delayed diagnosis.

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.