Why does breast cancer screening get skipped at routine visits?
Screening gets skipped because a yearly visit has a lot to cover. A mammogram is easy to forget when the visit is about something else.
A physical may focus on blood pressure, diabetes, or a new pain. The patient may feel fine. A busy doctor may assume another doctor, such as a gynecologist, is handling it. Electronic charts often show a reminder, but a doctor can skip reminders like these.
Guidelines have also changed, and they do not all agree. That can leave a doctor unsure what to say and when. Some women also put off screening for their own reasons, such as cost, fear, or past discomfort.
For woman in the appropriate age range, a yearly physical or well woman visit is the natural moment for breast cancer screening to come up. When it never comes up over several years, something has been missed.
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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.
Denise is 61 and lives near Altoona, Pennsylvania. For six years, she sees her family doctor every spring for a yearly physical. They talk about her blood pressure and her cholesterol. Her visit notes list her blood work and her flu shots. None of them mention a mammogram, the breast X ray used to look for cancer before there are symptoms. No mammogram is ever ordered.
One winter, Denise feels a hard lump in her left breast. A diagnostic mammogram, which is aimed at the problem spot, and a biopsy follow. A biopsy removes a small piece of tissue for testing. It shows breast cancer that has reached the lymph nodes, the small glands under the arm.
Denise wonders whether regular screening would have found it sooner. This article can help you sort out what your doctor should have raised, and when a missed screening may support a claim.
Is my doctor supposed to order my mammogram?
In most cases, yes. If you are in the age range, your primary care doctor or gynecologist is generally expected to raise screening at a yearly visit. They should then order it or help you set it up.
Two major guidelines set the schedule, and they differ:
- The US Preventive Services Task Force, a national panel of prevention experts, recommends a mammogram every two years for women 40 to 74. This advice dates to April 2024.
- The American College of Radiology and the Society of Breast Imaging, two groups of imaging doctors, recommend a mammogram every year starting at 40. Their 2023 advice sets no upper age limit.
Both start at 40. They differ on how often and when to stop. A doctor may follow either one.
For women 75 and older, the Task Force found the evidence too thin to recommend for or against screening. So for older women, the decision is often made one on one between the patient and the doctor.
The dates matter too. Before April 2024, the Task Force advised that most women receive biennial screening mammography starting at 50, with the choice in their forties made through one-on-one discussion with their doctor. A doctor’s care is judged by the guidelines in place at the time.
The visit note should show what happened. A careful note shows one of three things: a talk about screening, an order for a mammogram, or a note that you chose not to have one. If an order was placed, a careful office also checks that the mammogram was done.
Some women need to start earlier. The Task Force schedule does not apply to women at high risk. That includes women with a BRCA gene change or chest radiation at a young age. The American College of Radiology recommends that every woman have a breast cancer risk assessment by age 25. Our article on being told you were too young for breast cancer explains more. In Pennsylvania, Act 1 of 2023 covers extra screening for many women at higher risk in state regulated plans.
Where does the chance to find it earlier get missed?
- Years of physicals passed with no mention of screening. You saw the same doctor every year in the age range. No note shows a talk, an order, or a refusal.
- An order was placed but never followed. The mammogram was ordered, but it was never scheduled or done. No one noticed at the next visit.
- Each doctor thought the other was handling it. Your family doctor assumed your gynecologist ordered it, and your gynecologist assumed the reverse. Neither did.
- Your risk was not considered. You had a strong family history or other risk factor, but screening started late or not at all.
- Screening stopped too early without a talk. You reached your seventies and screening simply stopped, with no discussion of your health or wishes.
What should I check in my own records?
You can answer most of these from memory, your patient portal, or your records.
- How many yearly physicals or well woman visits did you have, and with whom?
- Does any visit note mention a mammogram or breast screening?
- Was a mammogram ever ordered? Was it done?
- Did you ever say you did not want one? Is that written down?
- Did anyone ask about breast cancer in your family?
- When was your last mammogram before your diagnosis?
Did the delay in diagnosing breast cancer change the outcome?
A missed step alone is not enough for a claim. The question is whether regular screening 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 and would likely have shown up on a mammogram. Others grow fast and may appear between screenings.
Medical malpractice lawyers and the experts they consult to review a case focus on a few things. They look at the tumor size at diagnosis and how long it likely took to grow. They check whether the cancer had reached the lymph nodes 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 first missed screening 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 mammogram not malpractice?
Not every delay is malpractice. A bad outcome does not prove someone made a mistake.
Your doctor followed a major guideline. Screening every two years under the Task Force, or every year under the radiology groups, is usually within the standard. A doctor is usually not negligent on schedule alone if either guideline was followed.
Screening was discussed and you chose not to go. If the note shows a real talk and your decision, a claim is much harder.
The cancer came up between screenings. You were screened on schedule, and the cancer appeared after a normal result. Some cancers do not show on a mammogram even when the test is done and read well. Our article on cancer found less than a year after a normal mammogram covers this.
The delay likely made no difference. A fast growing cancer may not have been visible at the last screening that was missed.
The strongest cases usually involve no screening discussion at all over several years.
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, most common first:
- 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, 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
At 40 for most women, under both the Task Force and the radiology groups. Women at higher risk may start earlier.
Every two years under the Task Force, or every year under the radiology groups. Both are accepted.
A talk about screening, an order for a mammogram, or a note that you chose not to have one.
Usually not. Claims are strongest when screening never came up over several years.
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Lupetin & Unatin, LLC represents Pennsylvania patients harmed by physicians who failed to meet the standard of care.