Errors All Too Common in Women's Cancer Care

Cheryl Clark, for HealthLeaders Media , May 20, 2009

As many as one in five women diagnosed with breast cancer had lesions that were visible but overlooked on most recent mammograms, and another 10% to 20% had lesions that were misinterpreted, according to a report summarizing recent research on cancer in women.

The synopsis was prepared by the Agency for Health Research and Quality in an effort to improve diagnoses, assure appropriate referral, and optimize the use of proven therapies for women with breast, cervical, ovarian, colon, and lung cancer.

Another important finding was that facilities that have the highest accuracy rates in detecting breast cancer offered only screening mammography, the routine exams that look for abnormal findings in all women, not diagnostic mammograms which attempt to interpret those abnormal findings.

"They had a breast imaging specialist on staff, and conducted audits of radiologists' performance two or more times per year," the report said.

The report also points out that so far, evidence suggests radiation therapy following breast-conserving surgery for a primary breast cancer reduces the risk of recurrence, but has only a small overall increase in survival. But, not performing radiation therapy after the primary cancer develops in the other breast appears to double the risk of dying.

"Women who did not receive radiation had slightly more than twice the risk of dying from breast cancer and 1.7 times the risk of dying from all causes as women who received radiation."

Some breast cancer surgeons at six New York hospitals do not encourage adjuvant treatment in one-third of a sample of 119 breast cancer patients, despite the fact that such treatment—including radiotherapy, chemotherapy and hormonal therapies—is recommended.

The report also pointed to a potential racial bias among oncologists in how they communicate with breast cancer patients. After videotaping visits of 405 women newly diagnosed with breast cancer during their visits with 58 oncologists, the researchers found that the doctors spent more time and "engaged in building relationships" with white women more than women of other races.

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