Breast cancer is one of the most common cancers affecting women. Early detection is a critical factor to improve outcomes and survival rates.
The cornerstone of preventive healthcare is regular breast cancer screening, primarily through mammograms. When doctors, nurse practitioners, and physician assistants don’t follow established standards of care, such as notifying patients about dense breast tissue or offering supplemental screening, the consequences can be devastating.
This article explores the importance of breast cancer screening, the role of dense breast tissue in detection, and how medical malpractice can arise when providers deviate from the standard of care, potentially delaying a breast cancer diagnosis.
The Importance of Breast Cancer Screening
Breast cancer screening is designed to detect cancer before symptoms appear, often at a stage when treatment is more effective. The primary screening tool is the mammogram, which is an x-ray of the breast that can identify abnormalities such as tumors or calcifications.
The American Cancer Society recommends that women at average risk begin annual mammograms at age 45. There’s an option of starting mammograms at age 40, though, At age 55, most women transition to screening every other year beginning at age 55. Once again, though, annual screening remains an option based on the preference and risk factors unique to each patient.
Mammograms are highly effective but not foolproof, particularly for women with dense breast tissue. Dense breasts have a higher proportion of fibrous and glandular tissue compared to fatty tissue, which can obscure small masses on a mammogram and, thus, reduce its sensitivity and accuracy.
Approximately 40% of women have dense breast tissue, and this is more common in younger women and those with a lower body mass index. Dense breast tissue is not only a risk factor for breast cancer but also a challenge in detecting it early through standard mammography alone.
This is why the standard of care requires recommending supplemental screening methods, such as whole-breast ultrasound or breast MRI, for women with dense breasts. These diagnostic tests can detect cancers that mammograms might miss, particularly invasive cancers as small as 0.4–0.5 cm. When used alongside mammograms, ultrasound or MRI tests increases the cancer detection rate, potentially identifying cancers at an earlier, more treatable stage.
Dense Breast Tissue and Legal Requirements
In Texas, a 2011 law known as Henda’s Law (House Bill 2102) requires mammography facilities to notify patients if they have dense breast tissue and to inform them that they may benefit from supplemental screening tests. This notification is critical because dense breast tissue can mask abnormalities on a mammogram, and patients are often unaware of their breast density or the added risk it poses. The law requires that patients be advised to discuss supplemental screening options, such as ultrasound or MRI, with their doctor or provider.
Henda’s Law was a response to growing evidence that dense breast tissue complicates breast cancer detection and that supplemental screening can improve outcomes. By 2021, this requirement was well-established as part of the standard of care in Texas, meaning that healthcare providers, including radiologists, nurse practitioners, and primary care physicians, were expected to comply. Failure to notify a patient about dense breast tissue or to offer supplemental screening options violates the standard of care, and can be the basis for a medical malpractice claim.
Medical Malpractice in Breast Cancer Screening
Medical malpractice occurs when a facility, doctor, or healthcare provider fails to meet the accepted standard of care, resulting in harm to the patient. In the context of breast cancer screening, malpractice may arise from several failures, including:
- Failure to Notify About Dense Breast Tissue: If a mammogram reveals dense breast tissue, the doctor or provider must inform the patient and discuss its importance. This includes explaining that dense tissue can obscure cancers on a mammogram and that supplemental screening, such as ultrasound or MRI, may be beneficial.
- Failure to Offer or Order Supplemental Screening: For patients with dense breasts, offering supplemental screening is often part of the standard of care, particularly when a mammogram is normal but the patient’s breast density increases the risk of a missed diagnosis. Ultrasound or MRI, for example, can detect small cancers that might be missed on a standard mammogram.
- Failure to Follow Up on Abnormal Findings: If a mammogram or supplemental screening identifies an abnormality like a mass or asymmetry, the physician or provider must ensure timely follow-up, including diagnostic imaging or biopsy, to rule out cancer.
- Misinterpretation of Imaging: Radiologists must accurately interpret mammograms and other imaging studies. Misreading a mammogram as normal when an abnormality is present can delay diagnosis and treatment.
When these failures occur, there can be life-threatening consequences. A delayed breast cancer diagnosis may allow the cancer to progress to a more advanced stage, requiring more aggressive treatment and reducing the likelihood of survival. For example, a cancer detected at Stage I has a five-year survival rate of nearly 100%, while Stage IV, where the cancer has spread to distant organs, has a survival rate of approximately 30%.
Case Example: Delayed Diagnosis Due to Lack of Notification
Consider a case where a woman – let’s call her Kaye – had had a screening mammogram that was interpreted as normal but showed heterogeneously dense breast tissue. After the radiologist interpreted the mammogram, Kaye’s nurse practitioner emailed her a short message that only said “normal results.” Neither the radiologist nor the nurse practitioner told Kaye about the added risk of her dense breast tissue or discuss supplemental screening options like ultrasound or MRI.
Two years later, Kaye had another mammogram that revealed a 4+ cm mass with metastatic spread to her bones. A new mother, Kaye was diagnosed with Stage IV breast cancer.
In this case, the failure to notify the Kaye about her dense breast tissue and offer supplemental screening in accordance with Henda’s Law deviated from the standard of care. If the nurse practitioner or radiologist had recommended an MRI or ultrasound been performed after the initial mammogram, the cancer would have likely been detected at an earlier stage. It would’ve been easily treated with a 95% survival rate. Sadly, now Kaye faces gruesome treatment and a grim prognosis.
Pursuing a Medical Malpractice Claim
If you or a loved one has been harmed due to a delayed breast cancer diagnosis, a medical malpractice claim may be an option to seek compensation for medical expenses, lost wages, pain and suffering, and other damages. To succeed in a malpractice case in Texas, you must prove four elements:
- Duty: The doctor or healthcare provider had a duty to provide care consistent with the standard of care.
- Breach: The doctor or provider breached that duty by failing to meet the standard of care. For example, not notifying a patient about dense breast tissue or offering supplemental screening is a clear breach.
- Causation: The breach directly caused harm, such as a delayed diagnosis that allowed the cancer to progress.
- Damages: The patient suffered measurable harm, such as advanced cancer, additional treatment costs, or reduced life expectancy.
An experienced medical malpractice attorney can help evaluate your case, gather medical records, and retain expert witnesses, such as breast imaging radiologists, to establish the standard of care and demonstrate how the provider’s actions fell short. In Texas, malpractice claims are subject to a two-year statute of limitations from the date of the injury or discovery, so it’s important to act promptly.
Conclusion
Breast cancer screening is a vital tool in the fight against breast cancer, but its effectiveness depends on physicians and healthcare providers following the standard of care.
For women with dense breast tissue, notification, counseling, and access to supplemental screening are not the law in Texas. When doctors and healthcare providers fail to meet these standards, the result can be a delayed diagnosis, allowing cancer to progress to a more advanced, less treatable stage.
If you suspect that a healthcare provider’s negligence contributed to a delayed breast cancer diagnosis, consult with a qualified medical malpractice attorney. By holding providers accountable, you can seek justice for the harm caused and help ensure that others receive the timely care they deserve. Early detection saves lives, and proper adherence to screening protocols is a critical step in that process.
