DC Metro Area Medical Malpractice Law Blog

Melanoma is one of the deadliest skin cancers, but new research demonstrates that melanomas located on the scalp or neck are even twice as deadly as those found on other parts of the body.  The finding is the result of a study published in a recent edition of the medical journal Archives of Dermatology. 

Colorectal cancer affects both men and women, and accounts for more deaths annually than all other cancers except lung cancer.  According to the U.S. Centers for Disease Control and Prevention (CDC), colorectal cancer is most often diagnosed in people who are 50 years of age or older, and the risk of being diagnosed increases with age. 

The CBS Evening News  with Katie Couric will have a report this Thursday about how military medical malpractice killed Sgt. Carmelo Rodriquez, a Marine who served in Iraq.  CBS News Bryon Pitts investigates in a heart wrenching extensive story, how military doctors misdiagnosed melanoma to be a harmless wart.  Pitts met the Marine, child and family by his side, 8 minutes before his death caused by Stage 4 melanoma.

His family insisted to be interviewed instead because they say Sgt. Rodriguez "...said don't let this be it.  Don't let this be it.  Fight!  That's what we are doing.  We're going to fight for him."  Laws prohibit the family to sue the military and his family had to pay for the funeral.

According to a veterans group that tracks soldiers who are misdiagnosed, there are hundreds of misdiagnosed cases across the country.

The full story will be broadcast Thursday on the CBS Evening News at 6:30 EDT.  It will reveal startling details about how family members of deceased servicemen and women have no legal recourse when malpractice among military medical doctors leads to irrevocable harm - and even death.

The diagnosis and treatment of lung cancer patients may be improved by routine imaging with positron emission tomography (P.E.T.), according to a recent research review published in the Journal of the National Cancer Institute.

According to a new study in the Journal of Clinical Oncology, between 1998 and 2003 in the U.S., there was a 150% increase in the number of women who opted to have both breasts surgically removed after being diagnosed with cancer of a single breast.  The surgical procedure -- Contralateral Prophylactic Mastectomy (CPM) may often be unnecessary, according to researchers, as most affected women never develop cancer in the second breast.

As reported in Medical News Today, scientists have developed a new, more accurate risk assessment model for breast cancer in African American women. The Breast Cancer Risk Assessment Tool, or Gail model, has been used for many years to determine breast cancer risk in all racial groups, however, much of the model is based on breast cancer data only from white women. The new study, called the Women's Contraceptive and Reproductive Experiences (CARE) study, was conducted in order to gather data on African American women with and without breast cancer. The study was conducted by Mitchell H. Gail, M.D., Ph.D. from the National Cancer Institute in Bethesda, Maryland, and his colleagues and is published in the November 27, 2007 online issue of the Journal of the National Cancer Institute.

The screening of 12 or more lymph nodes following colon cancer surgery -- a quality assurance practice recommended by the National Quality Forum (NQF), the American College of Surgeons (ACS) and the American Society of Clinical Oncology (ASCO) -- does not appear to improve the odds of 5-year cancer survival.  The finding is the result of recent research published in the Journal of the American Medical Association (JAMA). 

The American College of Obstetricians and Gynecologists (ACOG) has revised its colorectal cancer screening recommendations to encourage colonoscopy as the preferred method of screening both average-risk and high-risk women for colorectal cancer.  ACOG's previous recommendation was that all women above 50 years of age be screened for colorectal cancer, but no preference was given regarding the specific type of screening instrument.  The latest recommendation includes colonoscopy, specifically, because it allows for visualization of the entire colon surface and for removal of precancerous polyps simultaneously. 

A recent major epidemiological study led by McGill University researchers reveals that the human papillomavirus (HPV) screening test is far more accurate than the traditional Papanicolaou (Pap) test in detecting cervical cancer. The first round of the Canadian Cervical Cancer Screening Trial, led by Dr. Eduardo Franco, Director of the Division of Cancer Epidemiology at McGill's Faculty of Medicine, concluded that the HPV test's ability to accurately detect pre-cancerous lesions without generating false negatives was 94.6%, as opposed to 55.4% for the Pap test. The controlled randomized trial initially involved 10,154 women aged 30-69 years and spanned the years 2002 through 2005. It was the first of its kind conducted in North America for HPV testing as a stand-alone screening test for cervical cancer.

Inflammatory Breast Cancer (IBC) is deadly, and rarely detected in self breast exams or routine mammograms.  That's because it develops as a sheet, rather than in nodules or lumps that can more easily be felt or seen.  In many cases, IBC isn't diagnosed until it is too advanced to treat successfully; not only because it's difficult to detect, but also because it spreads much faster than typical breast cancers.  IBC is also relatively rare, accounting for between 1% and 5% of all cancers in the U.S.  According to experts at the Mayo Clinic, the following signs and symptoms are associated with IBC:

• "A breast that appears red, purple, pink or bruised
• A tender, firm and enlarged breast
• A warm feeling in the breast
• Itching of the breast
• Pain
• Ridged or dimpled skin texture, similar to an orange peel
• Thickened areas of skin
• Enlarged lymph nodes under the arm, above the collarbone or below the collarbone
• Flattening or retraction of the nipple
• Swollen or crusted skin on the nipple
• Change in color of the skin around the nipple (areola)"

Americans harbor a number of inaccurate and unsubstantiated beliefs regarding cancer -- particularly those Americans who are most at risk of developing the disease.  The finding is the result of a recent study by the American Cancer Society and published in the journal Cancer. 

The study centered on a telephone survey and the responses of random Americans with no prior diagnosis of cancer to 12 inaccurate or unlikely statements about cancer risks, some of which have recently been circulated as email hoaxes.  Two-thirds of the survey participants correctly identified 7 of the 12 statements as false, but more than 25% of those interviewed identified 5 of the 12 statements as true. 

"Good Morning America" host Robin Roberts recently announced that she has breast cancer, and will begin treatment with surgery.  The news and talk show host detected the cancer in its early stages immediately following her televised report of anchor Joel Siegel's battle with cancer, and the importance of early detection. 

Breast cancer genes can be inherited from a father, according to a new study published in the Journal of the American Medical Association.  Half of genetic breast cancers are actually inherited in this manner, but unless the father has female relatives with cancer,  the gene may have been passed down silently, without causing cancer.  Though men may develop breast cancer, it is rare. 

FREE  PROSTATE  TESTING & EXAMS :  Test Results within a Matter of Minutes

Call 202-741-3106 to schedule your free prostate testing and digital rectal exam offered by the GW Cancer Institute, GW Medical Faculty Associates, GW Hospital and the GW Medical Center.

Who:
• Men 45 and older
• African American Men 40 and older
• Not to be used for a second opinion

When:
• To schedule your free screening, please call 202-741-3106

Where:
• Ambulatory Care Center, 22nd and I Streets, NW, Washington, DC
  Second Floor
• Testing located one block from the Foggy Bottom Metro (Blue and Orange Line)
• Parking

What:
With the use of the Qualigen FastPack* blood-testing analyzer, men who participate in this GW program will get the results of their blood work and their exam as they leave the appointment. This is the first blood testing analyzer custom-designed to perform complex quantitative immunoassay tests. No need to take time off work, come during your lunch break to be tested—call 202-741-3106 to schedule an appointment today.

In the January 19, 2007 issue of its journal CA: A Cancer Journal for Clinicians, the American Cancer Society has recommended that girls ages 11 and 12 receive Merck's human papillomavirus (HPV) vaccine, Gardasil, which reportedly has been shown to be 100% effective in preventing infection with HPV strains 16 and 18.  It is believed that these strains together cause approximately 70% of all cervical cancer cases. In June 2006, the U.S. Food and Drug Administration approved Gardasil for sale and marketing to girls and women ages nine to 26, and the U.S. Center for Disease Prevention and Control’s Advisory Committee on Immunization Practices later that month voted unanimously to recommend that girls ages 11 and 12 receive the vaccine.  

According to a recent study, men may benefit far more than women from early colonoscopy screening for cancer.  Current guidelines call for average-risk men and women to begin colorectal cancer screening at age 50.  But the new findings, published in the New England Journal of Medicine, suggest there is a big difference in risk between the sexes at the recommended age.  The researchers concluded that to maximize the cost effectiveness of screening, men may need to be screened earlier, or women later, than current guidelines suggest. 

If you have questions concerning this topic, please contact the attorneys at Regan Zambri & Long or call us at 202-463-3030. 

While the Pap smear remains the best initial cervical cancer screening tool for younger women, a recent Danish study has found that for older women (women age 40 and older), a test for human papillomavirus (HPV) is a much more effective way to screen for this cancer.  According to the November 1, 2006 issue of Cancer Research, a publication of the American Association for Cancer Research (AACR), HPV infection is both frequent and transient in younger women, resulting in positive testing for HPV when no actual risk of cervical cancer exists.  In older women, however, HPV infection is rarer and more persistent, putting a woman at substantial risk for the disease before changes in cervical cells, detected by Pap smears, are obvious. 

"We have documented that a single HPV test can actually predict older women at risk for cervical cancer better than a single Pap smear can," said Susanne Krüger Kjaer, M.D., the study’s senior author and professor and head of the Department of Virus, Hormones and Cancer at the Danish Cancer Society.

A study in the Journal of the National Cancer Institute found that more than half of the American men who have their prostate cancer treated with surgery or radiation might have been just as well off using a “wait and see” program. As reported by Forbes, the researchers are now looking for a method to best determine which patients should be in which treatment group.

Scientists at Duke University have developed a new test, called the Lung Metagene Predictor, which is able to predict with near certainty whether the most common type of lung cancer will return after surgery. The 90% accurate predictions allow physicians to better prescribe a treatment for the patient.

Lung cancer is either classified as “small-cell” or “non-small-cell.” The small-cell cancer is treated with chemotherapy and non-small-cell is usually treated with surgery. However, nearly one-third of those patients who undergo surgery see a reappearance of the cancer in their bodies. The Lung Metagene Predictor will allow physicians to determine which patients will see the reappearance and prescribe a more aggressive treatment for them.

Duke researcher David Harpole says, “If we can use the test to increase patient survival by even 5 percent, we would save 10,000 lives a year. In reality, we can do much better than that.”

Tracking Lab Test Results and timely follow-up by your physician in terms of reviewing and acting upon all concerning outpatient tests is of paramount importance in avoiding medical errors.

According to the American College of Obstetrics and Gynecology (ACOG), every physician's office should have the appropriate procedures in place to ensure that patient's results are obtained for each test ordered.

According to Dr. Karen L. Bruden, a member of ACOG's Committee on Quality Improvement and Patient Safety, OB/GYN offices should be able to answer the following questions about their lab and testing tracking systems to ensure patient safety:

"1. Is a log kept of all cytology samples submitted to different labs? By whom?
2. Is there a mechanism for tracking delayed reports or those that were never received?
3. As a secondary safety net, are all patients instructed to contact the office regarding Pap results within a specific time period?
4. Who is responsible for receiving the cytology reports?
5. Does the physician see and initial all reports before they are filed in the patient's chart?
6. Is the cytology report attached to the chart at the time it is triaged by the physician (rather than put in a stack of "loose" reports)?
7. Are all reports triaged by the physician, or only abnormal reports?
8. If the physician reviews only the abnormal reports, who determines what constitutes an abnormal report? Are there written guidelines for the office staff?
9. What are the level of education and qualifications of nonphysician office staff who participate in the triage process? RN? LPN? colposcopy nurse? medical assistant? clerk?
10. Does the office have a "no-show" policy and mechanism in place?
11. At the end of the workday does the physician personally review the medical record of all patients who "no-show?"
12. Who is responsible for the recall of patients with abnormal cytology? Is a log kept to ensure that the patient was seen and the abnormal results addressed?
13. Is there a policy for the recall of patients who are not accessible by telephone?
14. Does the laboratory have a policy for notifying the clinician about abnormal results?
15. Is there a system for the physician to discuss results directly with the pathologist if needed?"

For more information on this topic, please visit the ACOG  website for more information regarding patient safety issues. The reader may also read more about this in the January 2006 policy statement issued by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO).

According to the National Cancer Institute, colorectal cancer is one of the most common forms of cancer.  However, if discovered early, colorectal cancer is one of the most curable types. 

Patients who are newly diagnosed with colorectal cancer experience a period of shock and disbelief.  Successful management of this or any other serious disease requires good communication between the patient and his or her physician.  Below are 10 important common-sense questions for newly-diagnosed patients to ask their doctor about colorectal cancer, excerpted from WebMd. 

"1)   How far has my cancer spread?
 2)   What are my chances for recovery?
 3)   What is your expereince in treating patients with this disease?
 4)   Am I likely to need a colostomy?  If so, might it be permanent?
 5)   What specialists will I see in my treatment and recovery? What will their roles be?
 6)   Which postoperative treatments do you recommend, if any?  Do I have any other options besides radiation or chemotherapy?
 7)   What side effects should I look for if I need those treatments?  Whom should I call about any bothersome side effects?
 8)   How often should I be screened for recurrent cancer?
 9)   Is there any way to help prevent the return of my cancer?
10) Can you recommend a good support group or resource where I can get more information?"

A good source for basic information about colorectal cancer is available through WebMD's cancer newsletter.

The following listing of websites provides helpful resources for women's health information:

National Women's Health Resource Center

U.S. Public Health Service's Office of Women's Health: National Women's Health Information Center

The Human Genome Group

Mammography Quality Standards Act (MQSA) Certified Mammography Facilities

American Medical Women's Association

OBGYN.net

JAMA Women's Health Information Center

Women's Health Initiative

The American Cancer Society's (ACS) annual guidelines for the early detection of cancer have been updated and are published in the January/February issue of CA: Cancer Journal Clinic. These guidelines summarize recommendations for early cancer detection, emerging issues for cancer screening, and data on cancer screening rates for adults in the United States. No new updates were published in 2005.

The American Cancer Society provides testing guidelines for several specific cancers, including breast cancer, colon and rectal cancer, cervical cancer, endometrial (uterine) cancer and prostate cancer.

According to a December 2005 report by Reuters Health, a recent study suggests that, from 1990 to 2002, the increased use of chemotherapy with surgery coincides with improved survival for advanced colon cancer patients. In fact, the use of adjuvant chemotherapy for these cancer patients rose from 39 to 64 percent during this interval, while the number of patients surviving for five years increased by 16 percent. The study, conducted by J. Milburn Jessup, M.D. and others from the National Cancer Institute, involved data from nearly 86,000 patients in 560 hospital cancer registries. During the study period, "the difference in survival between surgery alone and surgery plus chemotherapy increased," Dr. Jessup told Reuters Health. Moreover, Dr. Jessup suggested that present-day survival rates may be even better, noting that the data used in the study predated the development and use of newer and perhaps more effective chemotherapy agents.
For the complete Reuters Health report, please click here.

"In a review of cytologic-histologic specimen pairs, errors in cancer diagnosis were seen in up to 11.8% of cases, according to a report in the November 15th issue of Cancer. Moreover, in a substantial proportion of cases, the error caused some degree of harm for the patient."

One of the most frequent claims of medical malpractice that we handle involves failure to timely diagnose cancer. As with many cancers, early detection of colorectal cancer increases survivability. Since approximately 2000, the American Cancer Society has recommended that men and women at average risk begin routine screening at age 50. It is important to understand that these are very general guidelines for "average risk" patients and that individuals with risk factors require screening at an earlier age.

It is generally recognized that colonoscopy is the most effective diagnostic procedure for colorectal cancer screening. If you are experiencing any of the following symptoms, you should immmediately consult with your physician to determine if a colonoscopy is needed: blood in the stool; change in bowel habits; unexplained stomach discomfort; frequent gas, pains or indigestion.

Breast cancer is second only to lung cancer as a cause of cancer deaths in women in the United States. It is predicted that, this year alone, more than 200,000 women and nearly 1,500 men will develop breast cancer. The American Cancer Society currently recommends that breast cancer screening practices include annual mammograms for women at average risk beginning at age 40. Mammograms are imperfect, however, depending upon such factors as the skill of the interpreting radiologist as well as the particular kind of breast cancer that may be involved. For this reason, additional screening practices may include breast self-examination or a clinical breast examination conducted by a nurse or physician.