Why does a “probably benign” result get lost?
A probably benign result gets lost because it sounds like good news. The plan depends on someone remembering to bring the patient back months later.
A report like this does not ask for action now. It asks for action in six months. That gap is where things slip. Patients move, change doctors, or change insurance. Offices change computer systems. Reports land in a doctor’s inbox along with hundreds of others.
The words also play a part. “Probably benign” sounds close to “normal.” A patient may not know it comes with a plan. A busy doctor may file the report without placing an order or a reminder.
None of this means the finding was likely cancer. Most are not. But “probably” is not “definitely,” and the follow up is how the small chance gets checked.
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Article written by Gregory Unatin, Esq. Greg is a managing partner in the law firm of Lupetin & Unatin, a medical malpractice law firm located in Pittsburgh and serving Western Pennsylvania.
Our practice is limited to high-value catastrophic cases because that is where we can do the most for our clients and for patient safety.
The following is a hypothetical situation designed to demonstrate a common form of medical error. It is not a real case, and no physician has reviewed it or offered an opinion about it.
Joan is 58 and lives near Scranton, PA. Her yearly mammogram shows a small spot, so she is called back. She has a diagnostic mammogram, a detailed mammogram aimed at one area, and an ultrasound, which uses sound waves to make a picture. The report calls the spot “probably benign” and says to repeat the ultrasound in six months. A letter tells Joan her results are “probably benign.”
Joan reads that as good news. No one calls to schedule the next test. Her family doctor’s chart lists the report but has no plan.
Sixteen months later, her next mammogram shows the spot is larger. A biopsy, which removes a small piece of tissue for testing, shows breast cancer.
Joan wonders who was supposed to make sure she came back. This article can help you sort out who tracks a follow-up, and when a missed one may support a claim.
What does BI-RADS 3 mean, and who is supposed to schedule the follow up?
BI-RADS 3 means “probably benign,” with a chance of cancer of 2 percent or less. It comes with a plan for a short interval recheck, usually at six months, and continued checks for about two years.
BI-RADS stands for Breast Imaging Reporting and Data System. It is a rating scale from the American College of Radiology, a national group of imaging doctors. Each report ends with a number from 0 to 6. Category 3 is the only one that says “probably benign” and asks for a recheck instead of a biopsy.
A typical plan looks like this:
- A recheck about six months after the first exam.
- Another about a year after the first exam.
- A final check about two years after the first exam.
If the spot grows or changes at a recheck, the plan changes. A biopsy is often the next step.
Federal mammography rules also protect you. Under the Mammography Quality Standards Act, the imaging center must send you a letter with your results in plain words. That letter is in addition to the report sent to your doctor. Since September 10, 2024, it must also say whether your breasts are dense.
Who schedules the recheck depends on how the care was set up. In many cases, the doctor who ordered the imaging gets the report and is expected to act on it. Many imaging centers also run reminder systems and send letters when a recheck is due. Often both share the job. A careful system has a named person or process that tracks each recheck until it is done.
Your own role matters too, but it is rarely the whole story. A letter that says “probably benign” without a clear date or a reason to return is easy to misread.
Where does the chance to find it earlier get missed?
- No one placed the order. The report said to return in six months, but no order was written. Without an order, the recheck could not be scheduled.
- The reminder never went out, or went to the wrong place. The imaging center’s tracking system did not flag the date. Or the letter went to an old address.
- The report went to the wrong doctor. A covering doctor, an emergency room, or a doctor you no longer saw got the result. Your regular doctor never knew about the plan.
- The first recheck happened, and the rest were dropped. You came back at six months, and the spot looked the same. No one scheduled the checks at one and two years.
- A change at the recheck was called stable. The spot grew a little, or looked different, but the plan stayed the same. A change during follow up usually calls for a closer look.
What should I check in my own records?
You can answer most of these from memory, your patient portal, or your records.
- What number is at the end of each imaging report?
- What did the report say to do next, and by when?
- Which doctor ordered the imaging, and who got the report?
- Did you get a letter from the imaging center? What did it say?
- Was an order for the recheck ever placed?
- Did you get any reminder letters, calls, or portal messages?
- Were the rechecks done on time? Did any report say the spot changed?
Did the delay change the outcome?
A missed step alone is not enough for a claim. The question is whether a recheck on schedule would likely have found the cancer at an earlier, more treatable stage.
That depends on the cancer. Breast cancers grow at different speeds. Some grow slowly over years. Others grow fast. A delay of a few months may matter a great deal for one woman and very little for another.
Medical malpractice attorneys investigating a delayed diagnosis of breast cancer case and their experts need to look at few different things. They compare the size of the spot at the last exam to the tumor’s size at diagnosis. They check whether the cancer had reached the lymph nodes, the small glands under the arm that filter fluid, or other organs. They look at the type of cancer and how fast that type tends to grow. And they measure the time between the missed recheck and the diagnosis.
A delay can also change treatment. A woman who might have needed a small surgery may have needed a mastectomy, which removes the whole breast. Or she may have needed chemotherapy, strong cancer drugs, that might have been avoided.
In Pennsylvania, a family does not always have to prove that an earlier diagnosis would have saved her. It can be enough to show that the delay meaningfully raised the risk of harm. That added risk must also have played a real part in what happened.
When is a missed follow up not malpractice?
- Not every delay is malpractice. A bad outcome does not prove someone made a mistake.
- The rechecks were done on time. The spot stayed the same and was read correctly. Some cancers do not show on a mammogram or ultrasound, even when the test is done and read well. A doctor who did the right workup is not at fault just because the cancer was found later.
- The cancer came from a different spot. The finding being watched was truly harmless. A new cancer showed up somewhere else.
- You were clearly told and reminded. The order was placed, the reminders were sent, and the reason to return was explained. The recheck still did not happen. A claim is much harder in that setting.
- The delay likely made no difference. The stage would likely have been the same if the recheck had been on time.
What harms matter in these cases?
Our firm focuses on delays that led to death or catastrophic injury. In breast cancer cases, these are the harms that usually matter:
- Cancer that spread to distant organs, such as the bones, liver, lungs, or brain, before it was found. It can still be treated, but it can no longer be cured.
- Death from a breast cancer that, if found earlier, would likely have been curable.
What to Expect when you contact our office
Before we take a case, we review the records and imaging with medical experts. Pennsylvania requires a medical professional’s written statement that a claim has merit before a case can go forward. That review also helps answer whether the delay changed the outcome. A doctor, a nurse practitioner, a practice group, an imaging center, or a hospital system may each have played a role.
Pennsylvania has filing deadlines. For a living patient, the deadline is generally two years from a key date. That is when she knew, or should have known, that she was harmed and that medical care may have caused it. In delayed diagnosis cases, that date is often near the cancer diagnosis. After a death, claims generally must be filed within two years of the date of death. Learn more about how long you have to file a medical malpractice in Pennsylvania. For additional information on breast cancer misdiagnosis, see our main article on delayed diagnosis of breast cancer.
Frequently Asked Questions
It means “probably benign,” with a cancer chance of 2 percent or less. It calls for a recheck, usually in six months.
Usually about two years, with checks at about six months, one year, and two years.
Usually the ordering doctor, the imaging center, or both. A careful system tracks every recheck until it is done.
No. A claim needs a tracking failure and proof that the delay likely changed the outcome or raised the risk of harm.
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Lupetin & Unatin, LLC represents Pennsylvania patients harmed by physicians who failed to meet the standard of care.