Some Suggestions for Women Concerning Breast Cancer

Cases involving the failure to diagnose breast cancer are the most common kind of medical negligence. Only a fraction of the failures to diagnose breast cancer are ever the subject of lawsuits. Is that why mortality for breast cancer, despite improved treatment and diagnostic tools does not decline? I am concerned that part of the reason why these cases are so frequent involves the willingness of women to accept the word of a doctor — any doctor — when the word is something other than cancer. Another reason seems to be the willingness of male doctors to minimize a woman’s symptoms, even when it is a lump you can feel, and to believe old myths about what is and is not likely to be breast cancer. Most inexplicable, is the failure of some medical professionals to do what their own standard requires — they must rule out breast cancer when any lump appears. The things we can do to improve the chance of prevailing in a lawsuit for failure to diagnose breast cancer also would help us to survive it. Here are things women can do to enhance their chances of surviving breast cancer:

1. Do monthly self examinations. It takes only 2 minutes. If your excuse is that you have lumpy breasts (one I used for years) you must still do it. Soon you will learn what feels normal and you will have a chance of knowing when something is not.
2. Do not choose the doctor from the phone book. One of the best ways to select a competent doctor is to ask any nurse you know who works in local hospitals. If you don’t know any nurses, ask family and friends for a referral. You can also find out information about doctors through the Web. By going to www.AMA-ASN.ORG and typing in the name of a doctor, you can find out basic data such as where he or she went to medical school and whether and in what area he or she is board certified. Go to www.KNOWX.COM to find out whether the physician has been the subject of lawsuits. To learn whether a doctor has been the subject of discipline by state medical board go to www.FSMB.ORG which has direct links to each states’ medical board. Go to the state which will have information about your potential physician’s disciplinary record. Computerized record keeping has also made it possible to track incompetent doctors who move from state to state.
3. Have your breasts examined by a doctor once a year. The doctor should take plenty of time and should pay attention. He or she should be a board certified family practitioner, internist or OB/GYN. While he/she should ask about your family history, you should volunteer that information, if the questions are not asked. If one of your close relatives is diagnosed with breast cancer between visits, you should also bring that up.
4. Have an annual mammogram beginning at age 40, or age 30 if you have breast cancer in your family. Look at the films yourself, with your doctor or with the radiologist. If you see anything at all, ask what it is and how the doctor is sure it is not breast cancer. Have the mammogram done on a state of the art machine at a certified facility by a certified technician and make sure the films are read by a board certified radiologist. At the very least, do not assume after a mammogram that no news is good news. Instead, no news may be the result of someone having lost your films, lost the report, not even having done a report, or not reporting the results to the doctor or the doctor not reporting them to you. Any of those eventualities is a bad one. That is one of the reasons I suggest you look at the films yourself with one of the doctors. That way, you will know that someone who is capable of examining your mammogram has done so.
5. The following symptoms must send you rushing to the nearest qualified physician:
   1. ANY lump or swelling, painful or not, wherever located in the breast or underarm.
   2. Nipple discharge.
   3. Nipple turning inward.
   4. Redness, scaliness or irritation of the nipple or breast skin.
6. When you get to the doctor with one of these symptoms, don’t be hesitant to say right out loud – “I’m afraid I have breast cancer.”
7. If you have a lump, whether palpable or seen on a mammogram, I believe it should be biopsied – NO EXCEPTIONS. It is probably safe to wait one cycle to see if the lump is a cyst related to the menstrual cycle, which comes and goes depending on the time of the month. Of course, 9 out of 10 will be benign. Of course, some expense will be incurred by HMO’s and insurance companies. But we are talking about saving the lives of women. Saving lives is, after all, the purpose of health care. I am certain that a fair study would show that biopsies of all lumps are cost effective, when compared to the costs of overlooking breast cancer and treating it when it is advanced, not to mention the toll taken by the premature deaths of too many women from breast cancer that could have been successfully treated if timely diagnosed.

   It is NOT acceptable to wait any longer than one full menstrual cycle. If your doctor refuses to refer you for a biopsy of a lump that has lasted for that long, find another doctor. If your insurance company or HMO refuses to pay for a biopsy, find a good lawyer willing to file a class action on behalf of all the women served by that HMO or insurance company who may also develop lumps and be refused appropriate diagnostic care. Be sure to find out how long men with lumps in their testicles are required to wait before they are referred for biopsies paid for by the carrier or HMO. Be assertive. Ask questions. Share your fears. Women with lumps in their breasts have every right to be afraid. We are not hysterical. We are not overreacting. We are trying to save our own lives.

   Many women will still die from breast cancer, even if we all follow these steps. Some who would have died, however, will not.