BREAST CANCER STUDY ... 2002 Breast Cancer Study ..

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BREAST CANCER STUDY

• A STUDY OF ISSUES INVOLVING THE DIAGNOSIS OF
  BREAST CANCER THAT RESULT IN MEDICAL MALPRACTICE
  CLAIMS

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2002 Breast Cancer StudyFocus

• 450 cases involving paid claims with resolution
  dates no earlier than January 1, 1995 were
  analyzed.
• The study addresses only claims alleging a delay
  in the diagnosis of breast cancer.
• 25 PIAA member companies reported information.

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2002 Breast Cancer StudyMajor Findings

• More than 68 of the patients represented were
  under the age of 50.
• These claims account for 78 of reported
  indemnity.
• The average indemnity payment for claimants under
  50 was 63 higher than for patients 50 and older.
• Just under 33 of claimants were under 40,
  accounting for 43 of reported indemnity.

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2002 Breast Cancer StudyMajor Findings

• The patient most commonly found the lesion (59
  of the cases).
• A lesion was revealed by a screening or follow-up
  mammogram in 23 of the cases.
• A physician discovered the lesion in 14 of the
  cases.

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2002 Breast Cancer StudyMajor Findings

• Radiologists were cited most frequently as
  defendants. One-third of all paid claims were
  against radiologists.
• Radiologists are largely involved with the
  diagnosis of breast cancer as at least one
  mammogram was performed in more than 89 of the
  cases.
• The average indemnity payment for radiologists in
  this study was 337,090.

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2002 Breast Cancer StudyLeading Reasons for Delay

• 45 of cases involve a misread mammogram
• 43 reported that the findings of a physical exam
  failed to impress the provider
• 40 involved a negative mammogram report
• 36 failed to make a timely referral
• 28 involved a communication breakdown between
  providers
• more than one misadventure per case

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Presenting Symptom
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Who Discovered Lesion
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Physical Findings
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Initial Diagnosis
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Comparative Average Indemnity by Claimant Age
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of Claims and Indemnity by Claimant Age Group
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Average Delay in Diagnosis by Claimant Age Group
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of Claims and Indemnity by Severity of Injury
NAIC Severity Code
More Severe
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Average Severity of Injury by Claimant Age Group
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Average Patient Age by Severity of Injury
Age
NAIC Severity Code
More Severe
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Menopausal Status
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Delay by Patient
No Delay
Delay
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Average Indemnity for the Period of Delay in
Diagnosis
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Mammogram Results2002
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Mammogram Results1995
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2002 Breast Cancer StudySpecialty Breakdown
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2002 Breast Cancer StudyPercentage of Claimsby
Physician Specialty
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Most Common Physician Errors
Communication bet. providers
Failure to refer to specialist
Mammogram report negative
Physical findings did not impress
Mammogram misread
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Most Common Physician Errors of Errors Per Paid
Defendant
Communication bet. providers
Failure to refer to specialist
Mammogram report negative
Physical findings did not impress
Mammogram misread
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2002 Breast Cancer StudyComparisons to 1995 Study

• The average indemnity payment increased 35 from
  301,460 to 407,407. ALAE rose 58 in the same
  time period.
• Negative or equivocal results in cases where a
  first mammogram remained at 80.
• The average age of claimants dropped from 46 to
  45, and the median age dropped from 45 to 44.

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2002 Breast Cancer StudyRecommendations forAll
Practitioners

• Document all patient complaints regarding the
  breast.
• Document any family history of breast cancer.
• Document the results of any previous mammograms.
• Document the recommendations for subsequent
  diagnostic studies and follow up.

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2002 Breast Cancer StudyRecommendations forAll
Practitioners

• Remember to follow up with other physician
  consultants regarding test results etc.
• A palpable mass with a negative mammogram
  unequivocally requires tissue diagnosis.
• Pregnancy should not cause delay of appropriate
  diagnostic studies.

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2002 Breast Cancer StudyRecommendations
forPrimary Care Physicians OB/Gyns

• Do not abandon diagnostic pursuit because you are
  unimpressed by the physical findings.
• Perform a thorough breast exam on each female
  patient regardless of age or complaints.
• If a mass is palpated or suspected, additional
  studies must be done to rule out malignancy.
• Perform regular follow-up exams on patients who
  present w/ complications of the breast.

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2002 Breast Cancer StudyRecommendations
forRadiologists

• Repeat mammograms that result in films of poor
  technical quality.
• If the mammogram results are equivocal, recommend
  a repeat study, additional views, follow-up
  studies, other imaging modalities etc. as
  appropriate.
• Be sure an adequate physical exam was performed
  and documented.

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2002 Breast Cancer StudyRecommendations
forRadiologists

• Compare the results of any study to all previous
  studies.
• Promptly report your findings to the referring
  physician or the patient if self-referred. The
  patient should be advised of any abnormality and
  told to consult her GP or OB/Gyn.
• Make certain a thorough breast exam is done on
  self-referred patients. You are responsible for
  ensuring they receive proper follow-up visits.

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2002 Breast Cancer StudyRecommendations
forSurgeons

• Always perform an adequate examination of
  referred patients and document your findings,
  especially when they are unimpressive.
• Make sure the correct lesion is being removed for
  both open and needle biopsies. Always obtain a
  specimen x-ray.
• Promptly report consultation and biopsy results
  to referring physician.