BREAST CANCER STUDY

1. BREAST CANCER STUDY A STUDY OF ISSUES INVOLVING THE DIAGNOSIS OF BREAST CANCER THAT RESULT IN MEDICAL MALPRACTICE CLAIMS

2. 2002 Breast Cancer StudyFocus • 450 cases involving paid claims with resolution dates no earlier than January 1, 1995 were analyzed. • The study addresses only claims alleging a delay in the diagnosis of breast cancer. • 25 PIAA member companies reported information.

3. 2002 Breast Cancer StudyMajor Findings • More than 68% of the patients represented were under the age of 50. • These claims account for 78% of reported indemnity. • The average indemnity payment for claimants under 50 was 63% higher than for patients 50 and older. • Just under 33% of claimants were under 40, accounting for 43% of reported indemnity.

4. 2002 Breast Cancer StudyMajor Findings • The patient most commonly found the lesion (59% of the cases). • A lesion was revealed by a screening or follow-up mammogram in 23% of the cases. • A physician discovered the lesion in 14% of the cases.

5. 2002 Breast Cancer StudyMajor Findings • Radiologists were cited most frequently as defendants. One-third of all paid claims were against radiologists. • Radiologists are largely involved with the diagnosis of breast cancer as at least one mammogram was performed in more than 89% of the cases. • The average indemnity payment for radiologists in this study was $337,090.

6. 2002 Breast Cancer StudyLeading Reasons for Delay • 45% of cases involve a misread mammogram • 43% reported that the findings of a physical exam failed to impress the provider • 40% involved a negative mammogram report • 36% failed to make a timely referral • 28% involved a communication breakdown between providers *more than one misadventure per case

7. Presenting Symptom

8. Who Discovered Lesion

9. Physical Findings

10. Initial Diagnosis

11. Comparative Average Indemnity by Claimant Age

12. % of Claims and Indemnity by Claimant Age Group

13. Average Delay in Diagnosis by Claimant Age Group

14. % of Claims and Indemnity by Severity of Injury NAIC Severity Code More Severe

15. Average Severity of Injury by Claimant Age Group

16. Average Patient Age by Severity of Injury Age NAIC Severity Code More Severe

17. Menopausal Status

18. Delay by Patient No Delay Delay

19. Average Indemnity for the Period of Delay in Diagnosis

20. Mammogram Results2002

21. Mammogram Results1995

22. 2002 Breast Cancer StudySpecialty Breakdown

23. 2002 Breast Cancer StudyPercentage of Claimsby Physician Specialty

24. Most Common Physician Errors Communication bet. providers Failure to refer to specialist Mammogram report negative Physical findings did not impress Mammogram misread

25. Most Common Physician Errors% of Errors Per Paid Defendant Communication bet. providers Failure to refer to specialist Mammogram report negative Physical findings did not impress Mammogram misread

26. 2002 Breast Cancer StudyComparisons to 1995 Study • The average indemnity payment increased 35% from $301,460 to $407,407. ALAE rose 58% in the same time period. • Negative or equivocal results in cases where a first mammogram remained at 80%. • The average age of claimants dropped from 46 to 45, and the median age dropped from 45 to 44.

27. 2002 Breast Cancer StudyRecommendations forAll Practitioners • Document all patient complaints regarding the breast. • Document any family history of breast cancer. • Document the results of any previous mammograms. • Document the recommendations for subsequent diagnostic studies and follow up.

28. 2002 Breast Cancer StudyRecommendations forAll Practitioners • Remember to follow up with other physician consultants regarding test results etc. • A palpable mass with a negative mammogram unequivocally requires tissue diagnosis. • Pregnancy should not cause delay of appropriate diagnostic studies.

29. 2002 Breast Cancer StudyRecommendations forPrimary Care Physicians & OB/Gyns • Do not abandon diagnostic pursuit because you are unimpressed by the physical findings. • Perform a thorough breast exam on each female patient regardless of age or complaints. • If a mass is palpated or suspected, additional studies must be done to rule out malignancy. • Perform regular follow-up exams on patients who present w/ complications of the breast.

30. 2002 Breast Cancer StudyRecommendations forRadiologists • Repeat mammograms that result in films of poor technical quality. • If the mammogram results are equivocal, recommend a repeat study, additional views, follow-up studies, other imaging modalities etc. as appropriate. • Be sure an adequate physical exam was performed and documented.

31. 2002 Breast Cancer StudyRecommendations forRadiologists • Compare the results of any study to all previous studies. • Promptly report your findings to the referring physician or the patient if self-referred. The patient should be advised of any abnormality and told to consult her GP or OB/Gyn. • Make certain a thorough breast exam is done on self-referred patients. You are responsible for ensuring they receive proper follow-up visits.

32. 2002 Breast Cancer StudyRecommendations forSurgeons • Always perform an adequate examination of referred patients and document your findings, especially when they are unimpressive. • Make sure the correct lesion is being removed for both open and needle biopsies. Always obtain a specimen x-ray. • Promptly report consultation and biopsy results to referring physician.