Breast cancer: diagnosis, treatment and common errors which lead to litigation
Breast cancer is the most prevalent cancer in the UK. There are approximately 45,000 cases diagnosed and 12,500 deaths per annum in the UK alone. Recent progress in the fight against breast cancer, however, may mean that such aggressive development and fatality rates will become a thing of the past.
American scientists at the Cleveland Learner Research Institute have developed a prototype vaccine that targets proteins within the breast which they believe can prevent and even cure breast cancer. The treatment, which has been successfully tested on mice, reacts to breast cells which occur when women are lactating and also when cancer cells are present within the breast.
The lead researcher, Mr Tuohy, explained that the vaccine works by stimulating the immune system to protect the body against the breast cancer. It is his belief that this research could pave the way for further treatments whereby we could be vaccinated against breast cancer in the same way as children are vaccinated against polio and measles.
The researchers are now planning to conduct trials of the drug in humans. They warn, however, that it could be some years before the vaccine is widely available. It is vital, therefore, that whilst a vaccine or cure is still potentially several years from being available, women are aware of the causes and symptoms of breast cancer, as well as the treatment options that are currently available.
Symptoms of breast cancer
There are a number of symptoms of which women should be aware. In the vast majority of cases where these symptoms are present, however, there is no cancer. Despite this, it is important that women contact their GP if they do experience any of the following:
- A lump or thickening within the breast.
- Alterations in shape or size of a breast or nipple (for example nipple becoming inverted).
- Bleeding from a nipple.
- A rash on or around a nipple.
- A lump or thickened area in the arm pit.
For more information regarding symptoms of breast cancer, please refer to www.cancerhelp.org.uk.
There are a number of different factors which can affect the likelihood of developing breast cancer. Breast cancer is much more prevalent in some countries than others. Interestingly, when a group moves from a country which has a relatively low rate of breast cancer, for example Japan, to a country like Hawaii, where breast cancer is much more prevalent, the rate of breast cancer amongst the migrating Japanese soon matches that of the Hawaiians. This indicates that breast cancer is heavily influenced by environmental factors.
Contrary to popular consensus, development of breast cancer is not usually predicated by a genetic pre-disposition: it is not a cancer which generally “runs in the family”. Genetically induced breast cancer accounts for only 10% of new breast cancer cases. As a result, women are at risk of developing breast cancer irrespective of whether they have a family history of the condition. There are a number of risk factors that women should be aware of:
- Women who start menstruating early and / or women who have a late menopause (eg after the age of 55) are twice as likely to develop breast cancer.
- Not having children, or having your first child relatively late, seems to increase the likelihood of developing breast cancer.
- Using HRT for 5 years or more can double the risk of developing breast cancer.
- Where a women has been diagnosed with certain types of benign (ie non cancerous) lump, her chances of going on to develop breast cancer are 4 or 5 times higher. This is not true of all benign lumps.
- Obesity in post menopausal woman has been found to double the risk of developing breast cancer.
- Breast feeding reduces the risk of developing breast cancer by approximately 4 percent per year that breast feeding is undertaken.
- There is a link between family history and breast cancer, although it is only prevalent in 10% on new breast cancer cases. To date, 2 genes have been identified which are believed to induce breast cancer.
When potentially sinister symptoms are identified in a patient, medical professionals employ a Triple Assessment to aid with diagnosis. The Triple Assessment consists of:
- Physical examination.
- Breast imaging (mammograms and breast ultrasound).
- Cytopathology (removal of a small amount of cells from the breast using a needle. The cells are then examined for evidence of disease).
There are a number of different treatment options available for breast cancer. The treatments may be combined depending on the needs of the patient. In some circumstances a patient may have different options regarding their treatment, in which case, their breast care nurse will play an important role in advising the patient as to the possible treatment paths. Generally, where cancer has been diagnosed, a patient will be offered one, some or all of the following treatment options:
- Hormone Therapy.
- Biological Treatments.
For more information regarding treatment options for breast cancer, please refer to www.cancerhelp.org.uk.
Common errors which lead to litigation
The success rates for breast cancer treatments are improving year on year. Women who are diagnosed today are far more likely to have a positive outcome than was the case even 10 years ago. Unfortunately, however, sometimes treatment does go array, leading to a worse outcome for the patient and, in some instances, litigation. The following is a summary of the most common type of error:
- Where there is a non-cancerous lump, but the patient is not referred to a breast unit. Where a doctor identifies a lump, but believes it to be benign and so doesn’t refer the patient to the breast unit. Whilst a benign lump will never become cancerous, it may grow, resulting in a larger proportion of the breast being removed if it is decided at a later stage to excise the lump.
- Where the patient can feel a lump but her GP cannot. Not all lumps are easily identified by touch. If a GP fails to refer a patient to a breast unit because the GP cannot feel a lump, the GP may have been negligent should it transpire that the patient was actually suffering from breast cancer.
- Where there is no lump, but the patient has other symptoms - for example pain. One sided breast pain can be a symptom of breast cancer, even where there is no lump. A failure to refer a patient to the breast unit under these circumstances could be negligent where the patient is later diagnosed with breast cancer.
- Misinterpreted mammograms. A mammogram is interpreted by a breast radiologist. Sometimes the radiologist will report that the scan does not indicate cancer when in fact breast cancer should have been inferred from the scan. This is called a false negative. It can result in a delay in treatment. Conversely, a radiologist may report that a mammogram indicates that the patient has cancer when they do not. This is known as a false positive. It can result in a patient having to undergo unnecessary treatment. Both types of error can result in litigation.
- Delay in a patient being seen by the breast unit following a referral. Sometimes a patient may be referred to the breast unit for screening but there is a delay between when the referral was made and an appointment being provided by the breast unit. If the delay causes the patient to suffer a worse outcome than they would have done if an adequately prompt appointment were given, then a patient may have a right to claim compensation for the delay. This type of delay is much more common in younger women (ie under the age of 35). Typically a GP may make the referral to the breast unit without specifying that they suspect the patient may have breast cancer. The breast unit may then provide the patient with a routine appointment many months in future, by which point damage could have occurred.
- Failure to properly conduct the Triple Assessment. Due to the difficulty in detecting breast cancer using the psychical exam, mammogram or indeed biopsy techniques on their own, a properly undertaken Triple Assessment can significantly reduce the risk of a misdiagnosis of cancer. Where the Triple Assessment is not undertaken and a diagnosis of cancer is delayed as a result, the patient may succeed in a claim for compensation.
Researchers are developing new and more effective ways to identify and treat breast cancer. It is hoped that surgery and other such aggressive treatments may one day be a thing of the past. In the meantime, however, it is important for patients and health care professionals to be vigilant against this all too prevalent and devastating condition.
If you have experienced any of the difficulties discussed above, or are generally concerned regarding the treatment you have received for breast cancer, please contact Thompsons Solicitors.
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