Do Medical Rules Prevent or Cause Multiple Breast Cancer Surgeries?
Posted on behalf of Goldberg Finnegan, LLC on Mar 14, 2012 in Medical Malpractice
Debates about the ever-increasing costs of healthcare range from the influence of medical malpractice lawsuits, to the performance of "defensive" medical procedures by doctors, to the bilking of the American public by insurance companies and drug manufacturers. Whatever you're feeling on those issues, the bottom line is that doctors are responsible for creating standards of care within their profession. Simply, the standard of care is the minimum level that a physician must adhere to in order to be practicing medicine reasonably.
Problems arise when doctors do not address what the standard of care should specifically be in a particular area - this allows for some doctors to practice medicine in that area in a potentially unsafe manner. This appears to be the case regarding breast cancer surgeries. A New York Times article, "Breast Cancer Surgery Rules Are Called Unclear," evaluates the problems in the medical profession in this area of medicine.
A lumpectomy, the most common form of breast cancer surgery, is where only the tumor and some surrounding tissue are removed. Apparently, doctors don't agree on what to do after the initial lumpectomy based on the pathology results. A study by Dr. Laurence McCahill, Variability in Re-excision Following Breast Conservation Surgery, indicates that 22.9% of women had a repeat surgery. The pathology reports in half of those cases reveal that there were no cancer cells left behind, yet doctors went in again to remove more tissue.
The study also revealed that 14% of patients who had positive pathology reports did not undergo another surgery. This appears to be a clear failure to treat an existing problem. The longer a cancer remains in the body untreated before discovery, the more likely that the cancer will continue to grow, with worsening prognosis for the patient.
One of the problems is that doctors don't agree on how much tissue surrounding the tumor should be cut out.
Some doctors require only that no cancer cells touch the outer boundary of the excised tissue. Other doctors demand up to five millimeters of clean cells between the cancer cells and the outer margin. One doctor's research indicates that requiring a larger barrier of clean cells is not safer for patients. Another issue involved in the fray is that doctors are concerned about leaving breasts as intact as possible for cosmetic reasons.
But what about the patient? What is in her best interest? There are two main concerns for women with breast cancer. The first is that, when possible, all cancer cells should be removed. No matter what rule is declared, safety is the first priority and providing the best chance of survival. The second issue is the additional trauma to women diagnosed with breast cancer. Every test and every repeat surgery causes mental and emotional stress during an extremely tough time. Not only must doctors treat the physical problems, but they must also bear in mind the additional mental and emotional trauma that may be caused by their decisions.
If there is a way to reduce the percentage of repeat surgeries, while ensuring the removal of all cancer cells, it should be established as the standard of care. Until that time, involve the patient in which method is best for her. We are glad that physicians are studying and researching this issue, but it seems to us that if things are currently up in the air as to how exactly best to proceed, give the patient the choice: provide her with the information, the results of the studies, and allow her to make an informed decision about how she believes is the right way to proceed with her care. We think that is only proper.
If you have questions about breast cancer or a cancer misdiagnosis, contact our medical malpractice lawyers, including two nurse-attorneys, at 1.888.213.8140, or online. We handle medical malpractice lawsuits across the United States, and we have a proven track record.