Delay in Diagnosis of Cancer: A Far Too Common Medical Error

By: Sheila Hiestand

Medical errors account for over 250,000 deaths per year according to a recent study by Johns Hopkins, making it the third leading cause of death in the United States.  BMJ 2016;353:i2139, MA Makaray, M. Daniel (03 May 2016).  Unfortunately, many of these deaths are caused by a delay in diagnosis of cancers.  This article will examine two separate cases in which a delay of diagnosis resulted in a worsening of cancer staging and subsequent death, all of which could have been avoided had early diagnosis and prompt treatment been provided.

Diane C. was vigilant about her health.  When she turned 50, she promptly scheduled a screening colonoscopy as recommended by the American Cancer Society. (As of 2018, The American Cancer Society Guidelines changed to recommend screening begin at 45 years of age).  Upon exam, the gastroenterologist identified a worrisome polyp, which he attempted to remove.  Diane was informed after the colonoscopy that her exam had gone well, and while there was a polyp, it had been removed.  What Diane was not told was that the polyp had been sent to a pathologist, who determined that the polyp was cancerous, that the margins around the polyp were positive for cancer, and that the gastroenterologist had left cancer in the colon.  Not only was Diane never told of the cancer, she was actually informed that she only needed to repeat a screening colonoscopy in three years.  This gross medical error by the treating gastroenterologist left Diane with cancer in her colon, a cancer that would grow and spread throughout her body.

Diane went about her daily life unaware that cancer had been left in her colon, until some 15 months later when she began suffering from loose stools.  She immediately sought treatment, and was informed that the cancer, which was originally encapsulated in a small segment of her colon, had grown substantially and had spread to distant areas in her body, with multiple metastasis in her liver.  Because of the delay in diagnosis and treatment, Diane had progressed from a Stage 1 cancer, which is deemed “curable”, to a Stage IV cancer, which had only a 5% life expectancy at 5 years.  Diane died in less than two years.

In a similar case, Lisa B. noticed a mole on her torso had changed in shape and size over the course of a couple of months.  She went to her family doctor and saw his nurse practitioner.  The nurse practitioner performed a biopsy and removed the mole, and sent it to pathology, assuring Lisa that she would only call if the results were concerning.  Lisa was never told that the mole was in fact cancerous and that not all the cancer had been removed.  Six months later, the mole returned, and looked even worse than the first time.  This time Lisa was seen by the doctor, who located the pathology results when Lisa returned to the office.  By some mistake the results had not been reported to the doctor, and in fact had shown that the first biopsy was positive for melanoma.  As a result of the delay, the stage of the cancer had worsened, and Lisa was forced to undergo chemotherapy and surgical removal of 22 lymph nodes that would not have been required had she been diagnosed at the time of the first biopsy.

So how does one prevent these medical mistakes?  First, be vigilant with self-evaluation. While both Diane C. and Lisa B. were proactive in seeking prompt medical treatment, many patients delay treatment or screening, which can further postpone diagnoses and treatment.  Second, if you suspect cancer or have had a diagnostic test performed, demand that you personally receive the pathology reports and results.  Finally, upon receiving your pathology results, consider a second opinion for testing or interpretation of your results.  The fact remains that medical mistakes are the third most common cause of death.  Until this changes, vigilance and education may be the best tools there are to save your life.