By Penny Greenberg, RN, MS; Darrell Ranum, JD, CPHRM; and Dana Siegal, RN, CPHRM

Breast cancer is one of the most common cancers among American women -- affecting approximately 1 in 8 women -- and is the leading cause of cancer-related death. The good news is the overall rate of newly diagnosed cases began to decrease in 2000, and the overall death rate has continued to trend downward over the past 20 years.¹

Patients diagnosed with breast cancer must navigate the complex healthcare system while dealing with the emotions of their diagnosis and relying on the expertise, communication, and empathy of caregivers who practice in environments with inherent risks.

To better understand these risks and improve patient safety, The Doctors Company and CRICO Strategies recently partnered to study 562 breast cancer medical malpractice claims from 2009 to 2014 in CRICO's extensive Comparative Benchmark System (CBS). The analysis revealed two specific areas where harm occurred -- during initial diagnosis and during management and treatment.

The analysis identified 342 cases where there was a delay in diagnosing breast cancer. Failure or delay in ordering diagnostic tests, consults, or referrals and failure to have a system in place for communicating the results between providers can lead to missed or delayed diagnosis. Patient allegations in these cases were decreased chance of recovery, decreased life expectancy, or increased recovery time. Inadequate patient assessment, at 71 percent, was the top contributing factor identified by a panel of experts who reviewed the cases.

Harm occurred during the treatment and/or management of the patient in 220 cases, with the top allegation related to performance of surgery, including the initial surgery to remove the malignancy and subsequent reconstructive surgeries. Plastic surgery and general surgery were the primary services in nearly half of the cases, with many cases involving poor communication between the patient and surgeon -- especially related to informed consent.

Physicians treating breast cancer patients should consider the following risk reduction strategies:

• Obtaining an accurate and timely diagnosis -- including interpretation of diagnostic studies, updated family history, comprehensive exam, and thorough medical record review -- is critical to ensuring the best possible outcome for patients.
• Use decision support tools such as a breast care management algorithm and an effective referral tracking system to assist in diagnosis.
• Implement processes, including documentation forms, to support an interactive informed consent process.
• Utilize CRICO's Safer Care modules so that all members of the care team can help prevent patient harm in the course of diagnosis and treatment.
• Refer to resources such as The Doctors Company's interactive guides to identify system weaknesses and to develop reliable processes.

Acknowledgments

For help in developing this article, the authors extend their thanks to Robin Diamond, JD, RN, senior vice president of Patient Safety and Risk Management at The Doctors Company.

This article was originally published in Patient Safety & Quality Healthcare (www.psqh.com).

Reference

1. A snapshot of breast cancer. National Cancer Institute. November 5, 2014.
   http://www.cancer.gov/research/progress/snapshots/breast. Accessed August 5, 2015.