FEMALE BREAST CANCER AND MISDIAGNOSIS
Female breast cancer is one of the most insidious cancers of all. It not only threatens the lives of its victims, it often causes noticeable disfigurement that can exact an additional emotional toll. Diagnosis and treatment is complex and can be fraught with misdiagnoses by medical professionals. All women should be on high alert to make sure they are screened appropriately and, if diagnosed with cancer, that they receive the right treatment for their personal situation.
According to Breastcancer.org, approximately 1 in 8 women will suffer from invasive breast cancer during her lifetime. It is estimated that nearly 230,000 new cases were diagnosed in 2015 in the United States, and about 40,000 women were expected to die from the disease. Other than lung cancer, breast cancer kills more women than any other form of cancer. But there is also improvement on the breast cancer front.
The good news about breast cancer is twofold: 1) the incidence rate has been decreasing for the past dozen or so years, and 2) early detection and successful treatment is on the rise, which means a decrease in deaths. One reason for the drop in the incidence rate is thought to be a decrease in the use of hormone replacement therapy (HRT) by post-menopausal women. A study published in 2002 found that certain HRT carried health risks, including breast cancer. While most physicians are paying attention to the study, others may not. Consequently, an unsuspecting patient seeking to avoid the discomfort of menopause may be prescribed dangerous hormone replacement therapy without the knowledge of its cancer-causing properties. Such a lapse of judgment by a treating doctor could be a serious medical error.
Regular screening for breast cancer through self-examination and mammography has contributed to early detection and treatment. Activism on the part of breast cancer support organizations, particularly Susan G. Komen, has increased public awareness of the importance of regular examinations and mammograms. In addition, health care insurers and providers have made mammograms very accessible.
Types of Breast Cancer
The female breast is made up of lobules, ducts, and stoma. The lobules produce milk, the ducts carry milk to the nipple, and the stoma is tissue that connects them together. Cancer most typically starts in the ducts, although it can originate in both the lobules and the stoma.
The vast majority of breast cancer is known as invasive ductal carcinoma (IDC). It starts in the ducts and spreads to the other breast tissues. It accounts for about 80% of all breast cancer cases. IDC has several cancer subtypes that involve specific types of tumors. A less serious cancer in the ducts is non-invasive ductal carcinoma. This cancer is confined to the ducts and has not spread beyond their walls.
Cancer can also develop in the lobules. Invasive lobular carcinoma (ILC) is the second most common breast cancer even though it only accounts for 10 percent of breast cancer cases. Like its ductal counterpart, ILC has spread beyond the lobules and invaded other breast tissue. There is also a non-invasive variety of lobule cancer where the diseased cells have not spread.
Metastatic breast cancer is cancer that has moved from the breast to other parts of the body. This occurs either when symptoms have been ignored or gone undetected until reaching this serious stage or a previous cancer has been treated and the remaining cells have gone undetected while spreading. Recurrent breast cancer is diagnosed when cancer has returned to the same breast, the other breast, or the chest wall after a period of non-detection.
Medical providers play a large part in preventing cancer from metastasizing. If initial diagnosis or treatment is delayed, the risk of cancer spreading can increase significantly. In the case of recurrent breast cancer, a failure to diagnose or to misdiagnose the return of the cancer in a different location is life-threatening and may be a cause for legal action.
Causes and Risks
Only about five to ten percent of breast cancer cases are considered to be hereditary. Such cancers often occur early in life, occur in both breasts, or are accompanied by ovarian cancer. Researchers have isolated two genes, BRCA1 and BRCA2, which can be determined, through testing, to contain mutations that greatly increase the risk of breast cancer.
The bulk of breast cancers are a result of various things that can be intertwined. Age is one the biggest factors. Our genes do not remain static as we grow older; abnormalities naturally develop. Two-thirds of invasive breast cancers occur in women over 55 years of age and result from the effects of aging.
Certain changes occur in the breast over time. For example, excessive growth of cells can develop. The cells may not be immediately cancerous, but if it occurs, the risk of eventually developing cancer increases. If the extra growth involves normal cells, the risk is doubled. If the cells are abnormal, the risk is quadrupled. If abnormal growth occurs in the lobules, the risk can be 10 times more than normal.
There are other risk factors not related to aging that may serve as a foundation for cancer later in life. The most cited are as follows:
- Radiation exposure in the chest area prior to the age of 30;
- Being overweight;
- Having a first child after age 30;
- A less than full-term pregnancy;
- Commencement of menstrual cycles prior to age 12;
- Going through menopause after age 55;
- Having dense breast tissue; and
- Drinking alcohol.
It is critical that patients be proactive in telling their doctors about these risk factors, and it is equally important that doctors take them seriously to facilitate quick diagnosis and treatment.
Symptoms and Misdiagnosis
The most common symptom of breast cancer is a lump. A lump may occur for several reasons, cancer being only one. Infection, injuries, and non-cancerous cell growth are common sources. Typically if a lump is painful, it is less likely to be cancerous. Pain is normally present with infection and inflammation, which are not normally components of cancer. That is not to say that a non-painful lump is cancerous. Benign tumors are not normally painful either. Regardless of the presence or absence of pain, however, lumps are easy to get checked out, and that should be done immediately.
Other less common symptoms include the following:
- Dimples in the skin;
- Generalized breast pain;
- The nipple turning inward;
- The nipple becoming scaly, red, or more thick;
- Fluid discharge from the nipple other than milk; and
- A lump under the arm.
If you experience any of these symptoms, tell your doctor immediately. Your quick reporting, coupled with proper diagnosis and treatment by your doctor, is essential to enhance your chance of survival.
Breast cancer is most often misdiagnosed at the biopsy stage. The doctors who review tissue samples are pathologists. These doctors can incorrectly classify tissue as non-cancerous when that is not the case. This occurs more frequently when the sampled tissue is atypical—that is, it is not like the most common cancerous tissue found. Doctors may also misdiagnose a tumor as being benign based on mammogram results and never order a biopsy.
Additional Mental Toll
Any kind of cancer diagnosis imposes an emotional toll on the victim. Breast cancer, however, can cause additional anguish because of the body part affected and its potential outward manifestation. Women who have had surgery to treat their cancers may feel unattractive or unfeminine afterward. These feelings often create uncertainty and stress in their intimate relationships. Counseling is often recommended to help victims cope with the emotional effects of cancer, particularly breast cancer.
Misdiagnosis and Delayed Diagnosis
While breast cancer is increasingly detectable and treatable, it remains a substantial threat to women’s health. There are multiple treatment options available, and deciding which path to take requires top-notch medical information. Victims should seek out a cancer facility that is highly specialized in breast cancer treatment. They should also learn as much as they can about the way breast cancer works in order to assess treatment options. They should recognize the potential for misdiagnosis or delayed diagnosis and push their doctors for answers.
Even medical professionals recognize the danger of relying solely on the recommendations or decisions of doctors. Claire Fagin, Dean Emeritus of the University of Pennsylvania School of Nursing, said “[T]he best patients are the worst patients. Nudge, nudge, nudge. Don’t sit back and accept anything that fails to satisfy you. Speak up, protect your interests.”