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    The 3 Cancers Unique to Females
    Breast Cancer, Ovarian Cancer and Cervical Cancer

    Breast Cancer
    Breast cancer is probably the most often reported medical negligence claim involving women. Breast cancer can be defined as a new and abnormal formation of tissue as a tumor or growth. Tumors can be malignant or benign. Malignant tumors are cancerous. The tumor grows at the expense of the healthy organism. The growth infiltrates the tissue, spreads (metastasizes) and often reoccurs after attempts at surgical removal. Breast cancer is the most common malignancy among women and accounts for 27% of all cancers and 18 % of all cancer deaths. While breast cancer is one of the most common cancers it is also fortunately one of the most treatable of all human malignancies. How is breast cancer detected? The following list sets forth the ways in which to detect breast cancer.

    1. Self examination(BSE). Breast self examination is especially useful in the early detection of breast cancer. The examination may reveal a palpable mass.
    2. Physical examination by a physician
    3. Mammography x-ray of the breast is capable of detecting 85% to 90% of existing breast cancers. Women in the high risk group for breast cancer (ages 40-49 ) should have mammography every one to two years. Women over 50 should have annual mammography. Mammography as a diagnostic tool cannot replace a careful periodic physical examination. This is especially true for women with dense, fibrous breast tissue in which lesions are difficult to detect. There is substantial controversy regarding the use of screening mammography for women under 50.
    4. Ultrasonography produces an image or photograph of the tissue.
    5. Aspiration biopsy.

    Cancer cells become even more dangerous when they break away from the tumor and enter the blood stream or lymph system. This process is called metastasis. Progressive metastasis often leads to death. For this reason, a failure to properly diagnose cancer is a significant breach in medical care.

    Delay in Treatment
    Delay in the diagnosis of breast cancer arises in several contexts:
    (1) the physician's failure to appropriately evaluate a complaint of a palpable mass, (2) failure to properly read a mammogram, (3) inappropriate reliance upon a negative mammogram in the face of a palpable mass, and (4) failure to perform additional tests such as aspiration biopsy and/or open biopsy of a mass. These are the most common ways in which physicians commit malpractice in connection with breast cancer.

    Causation
    Of course, any negligent delay by the physician must be the proximate cause of damages, which, absent the negligence, would not have occurred. That is, the victim must prove that had there been an earlier diagnosis there would have been a change for the better in either the relapse rate or the survival rate.

    OVARIAN CANCER
    Ovarian cancer is the most frequent cause of gynecologic cancer death because 2 out of three of the cases are detected in advanced stages. Late detection is reflective of an absence of specific symptoms while the disease is still localized, as well as the lack of effective strategies for prevention or screening. Nearly 1 woman in 70 will develop the disease. Over the past 25 years there has been a steady increase in the ovarian cancer rate. Unfortunately, there are no early specific signs or symptoms that mark ovarian cancer, which means that by the time the diagnosis is made, it is at an advanced stage.

    Diagnostic Evaluation
    The primary symptoms (nausea, dyspepsia and lower abdominal discomfort) are too vague to suggest the beginning of an ovarian cancer; thus, there is a definite need for a routine gynecologic examination beginning prior to the first menstrual period. A mass in the area of the ovaries, often in the form of a cyst, indicates the need for an exploratory laparoscopy, for the mass may be a cancerous growth. Ovarian enlargement during the reproductive years is usually benign. Patients over 40 are at a greater risk for ovarian cancer. Ovarian cancer develops in the following stages: Stage I (growth limited to the ovaries); Stage II (growth involving one or both ovaries with pelvic extension); Stage III (tumor involving one or both ovaries limited to the pelvis); and Stage IV (growth involving one or both ovaries with distant metastasis). Pap smears are rarely positive for ovarian cancer. Ultrasonography is the considered the safe, non-invasive procedure of choice to determine the presence of intrapelvic disease.

    Causation
    As with other forms of cancer, the plaintiff can only recover significant damages if the disease is discovered at an early stage. Unfortunately, in 75% of all patients, ovarian cancer has spread beyond the ovary at the time of diagnosis. Diagnosis is rarely made when the patient is in Stage I of the disease. The ultimate legal question with regard to the diagnosis of ovarian cancer is whether, when the physicians saw the patient, the diagnosis should not have been missed in light of the available developmental facts.

    CERVICAL CANCER
    Background
    Preinvasive lesions of the cervix can be detected reliably by obtaining a Pap smear. The American Cancer Society recommends that a Pap smear be obtained every 3 years after 2 negative Pap smears were obtained at yearly intervals. Many gynecologists recommend yearly Pap smears. Carcinoma of the cervix is the third most frequent of the female genital cancers. Pap smears are read by laboratories, and it is important to examine old Pap smears to find out of they were properly read by the evaluator. Leading candidates for cervical cancer are those women in low a socio-economic status, those who begin sexual intercourse at a young age, those who have more than one sexual partner, women who become pregnant at a young age, and women who have more than one child.

    Diagnostic Evaluation
    The two methods to determine the occurrence of cervical cancer are Pap smears and a gynecologic examination. As of 1988 the American Cancer Society recommended all women who are or have been sexually active or have reached the age of 18 years, should have an annual Pap test and pelvic examination.

    Causation
    Cervical cancer which is identified early has an excellent prognosis, but the prognosis worsens with each advancing stage of the disease. From a legal point of view, the best case scenario involves a woman who has a misread Pap smear, where the correct diagnosis does not take place until an advanced stage of the disease when the only remaining treatment is a hysterectomy, followed by chemotherapy with a poor prognosis.

     

    This informational piece was prepared by Monheit, Silverman & Fodera. If you would like more information on this topic, call us at (800) 220-LAW1, or use the "Do I Have A Case?" button on this web site.


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