Breast Cancer Misdiagnosis is Common in Young Women

In November 2000 38-year-old Robin Gray RN, native of
Baltimore, MD and current resident of Upstate New York, was smooth
sailing through life and enjoying her brand new dream home with her
husband and her three young boys, ages 2, 7 and 9 years of age. Then
out of the blue one day, just prior to Thanksgiving, she took a bath
and was shocked to find a tiny pea sized breast lump and was
immediately terrified, especially since she knew her grandmother had
died of breast cancer.

Like many women Robin turned to experienced physicians for
consultation, assessment, and guidance. She was especially confident in
her doctors, as her husband, a medical doctor in a small Upstate NY
town, had recommended them. A mammogram, breast ultrasound, and
clinical breast exams were done by a radiologist and Robin was told
that her lump was only a cyst and she only needed to see a surgeon for
long term-monitoring. When she saw the breast surgeon, she received
another breast ultrasound and clinical exam and was told the lump was
benign fibrocystic breast condition, nothing to worry about, and that a
lot of young women have breast lumps. She was also scheduled for
follow-up in three weeks, and when that appointment arrived, she was
again reassured that her lump was benign. When the cyst started to
enlarge, three months later, Robin saw her breast surgeon again, and he
said that breast cysts could harmlessly increase in size in
pre-menopausal women like her. Then he did a fine needle breast biopsy
for the lump enlargement, aspirated fluid, and assured Robin her lump
was only a cyst. A pathologist also rendered an opinion on the fine
needle aspiration biopsy, declaring it was benign. About six months
later, Robin returned to the same breast surgeon, informing him that
the lump seemed larger and that she was worried, especially since her
other grandmother just died of breast cancer. The surgeon did another
breast ultrasound and assured Robin once again that lump was benign and
that second degree relatives, like grandmothers, would not increase
one’s risk for breast cancer.

A long six month later and seventeen months after Robin had first seen
her doctors for a breast lump, she returned to her breast surgeon once
again, as the lump was very large and uncomfortable, and she received a
repeat fine needle aspirate biopsy, alarmingly learning that she had
breast cancer.
Finally, her surgeon removed her lump, which increased in original size
from a small quarter inch lump to about 7 cm in diameter. Due to the
large size, it required ultimately a mastectomy, nodal dissection, and
an additional excisional surgery to clear the extending margins of the
untreated cancer. Furthermore, she required chemotherapy, as cancer was
found to have spread to her lymph node. She also required Herceptin for
her aggressive cancer subtype, often found in young women.

Despite the fact that Robin had doctors with years of medical
experience assess her breast lump, she was ultimately delayed diagnosed
with breast cancer for almost a year and a half, resulting in many more
treatments with a worse prognosis.
Nothing in her years of training as a nurse prepared her to be able to
avoid a breast cancer misdiagnosis. Nor was her husband, a medical
internist physician, able to guide her from avoiding a misdiagnosis, as
he literally could not see the mistakes that his physician colleagues
were making.

After Robin’s misdiagnosis and following months of more aggressive
surgery and medical treatments required as a result of the delayed
diagnosis, she was finally able to catch her breath to investigate the
mystery behind her misdiagnosis.
She had several physicians give second opinions, third, and even fourth
opinions on her mammogram, breast ultrasounds, and breast biopsy.
Through these opinions, she ultimately discovered that there were
multiple errors in her breast diagnostic testing and that her surgeon
over-relied upon a needle aspirate biopsy rather than doing a more
definitive core or excisional biopsy. She did eventually file a medical
malpractice lawsuit and settled out of court, and she filed a complaint
with the Office of Professional Conduct in her state against her
negligent radiologist, surgeon, and pathologist who misdiagnosed her.

Robin’s story is not uncommon. At least ten thousand
women per year are misdiagnosed with breast cancer and most of these
women are young! (1) Physicians commonly misdiagnose young women due to
age bias where breast cancer is not expected in a young woman, as the
median age for a breast cancer diagnosis is 63 years old. (2) As a
result, often physicians do not do all the correct tests and aggressive
procedures to adequately rule out cancer, thinking cancer is not
possible in a young women. (3, 4) This is particularly unfortunate as
young age is a negative prognostic factor in breast cancer diagnosis,
where cancer is often more aggressive, and a delayed diagnosis may
gravely impact on prognosis. (5)
Today, Robin is a seven year survivor. She is just
happy to be alive and tries to live one day at a time to its fullest,
while moving forward and putting her misdiagnosis behind her. She feels
miraculously blessed to be here enjoying her family of three boys and a
loving husband.

She
also feels a calling to turn her tragic experiences into something
positive for others and educates other women that it is not enough to
just see a doctor when a breast lump is found. Instead, Robin
suggests that women need to become their own advocates. She recently
published a book about her experiences, called BREAST LUMP WHAT LIES BENEATH,
in order to help increase awareness of breast cancer in young women, to
increase awareness of the epidemic of doctor-related breast cancer
misdiagnosis in young women, and to help guide women in how to obtain
the correct breast diagnosis. Robin also believes her story will
encourage those who have already suffered a misdiagnosis or cancer
diagnosis. You may visit her new educational website,
with life-saving information about breast lumps and emotional healing
information for a misdiagnosis or cancer diagnosis. A percentage of the
proceeds from her book will go to the Young Survival Coalition.

Bibliography

(1)(3)-Goodson, William H. III, MD, Moore, Dan H. II, MD.