Cancer of the breast has received tremendous attention in our society. Today, cancer of the breast is a leading cause of death among women. Fortunately, breast cancer can be cured.
Interestingly, breast cancer was also known to ancient civilizations. One of the oldest treatises in medicine written around 2609 B.C. describes tumors and care for breast cancer. This disease was known in the ancient civilizations of Egypt, Babylonia, Greece, and well known throughout the Middle Ages. In the 19th century, with the introduction of anesthesia in the United States in 1846, treatment of breast cancer changed dramatically. Surgery now became available to women for curing this disease. In the 20th century, treatment of this disease again dramatically changed. Surgery became more refined, radiotherapy became available, hormonal therapy became available, chemotherapy became available and, most importantly, mammography became available.
Mammography is a low dose x-ray examination of the breasts. It is a breast imaging procedure used to detect and diagnose breast cancer. First developed in the United States in the 1930’s. Mammography is now considered to be very sensitive and accurate in the early detection of breast cancers. There are two kinds of mammographic procedures. One procedure is called screening mammography and is used to detect unexpected breast cancers. Another kind of mammography is known as diagnostic mammography. This breast imaging procedure is used to evaluate patients who have symptoms in their breasts such as a lump or discharge from the nipple.
Another kind of breast imaging procedure is known as ultrasonography. An ultrasound uses sonic energy to produce an image of the breast. After mammography, it is the most frequently used study for the diagnosis of breast cancer. Other diagnostic procedures that can be used to diagnose and detect breast cancer include digital mammography, magnetic resonance imaging (MRI) and radionuclide imaging.
Because screening mammography is so capable of detecting and diagnosing breast cancer, guidelines have been established for the use of screening mammography. Keeping in mind that each year close to 200,000 new cases of breast cancer are diagnosed and around 50,000 women die of breast cancer, one can easily see how important early detection is. The risk of developing breast cancer increases with age. Women beyond the age of 40 are at the greatest risk. In addition, there are other risk factors which have been identified which put women at an increased risk for developing breast cancer. Although there has been some controversy surrounding the use of screening mammography for women between the ages of 40 and 50, the American Cancer Society, the National Cancer Institute and many other major medical organizations do recommend mammographic screening every one to two years for women aged 40 to 49. There is universal acceptance that women 50 years and older benefit from annual screening mammography.
In addition to mammography and other breast imaging studies, detection rates of breast cancers have also significantly improved because of breast self examination. It is recommended that women start breast self examination in their 20’s and continue this for the rest of their lives. The self examination should be performed 5 to 10 days after the onset of menses. Post-menopausal women should do the examination on the same day of each month. The breast self examination should be conducted in a three step method. First, the inspection should occur before a mirror with the arms at the side. The arms should then be raised straight up in the air overhead and on the hips. One should look for any changes in skin color, contour, and nipple changes. Second, the breast should be palpated in the shower. Third, the breast should be palpated in a lying down position on a couch or in the bed. Any abnormalities seen or felt should immediately be brought to the attention of the physician.
Even with breast self examination and breast imaging procedures, there will also be breast cancers which will remain undetected. Unfortunately, women will still die even when they receive the best of medical care. Standards of medical care are frequently violated in the early detection and treatment of breast cancer. Any physician who ignores a patient’s complaints of a lump in the breast, a change in the texture of the breast, a change in the color of the breast, or a complaint of nipple charge has violated appropriate standards of medical care. The failure of a doctor to order breast imaging studies and other diagnostic procedures in the face of physical complaints by a patient about her breasts has violated applicable standards of medical care. Also, radiologists can violate the standards of care in the interpretation of breast imaging studies, most frequently mammograms and ultrasounds. Breast cancers which are clearly shown on mammograms and ultrasounds can be overlooked by the radiologist. Even though a radiologist may see an abnormality on a mammogram or ultrasound, sometimes they are under-read. Last, if a patient presents for a screening mammogram, and tells the technician or radiologist of an abnormality in the breast on physical examination which has been detected by the patient, the radiologist or technician is obligated to then convert the screening mammogram into a diagnostic mammogram. A diagnostic mammogram is much more capable of detecting an early breast cancer than a screening mammogram.
If you or a loved one currently suffers from breast cancer and believe that you have not been afforded appropriate medical care, call us for a free consultation.
Patient wins jury award
A Mercer County jury awarded $12.8 million yesterday to a Hermitage schoolteacher who had filed a malpractice lawsuit against two doctors for failing to diagnose her breast cancer.