Delayed Diagnosis of Lung Cancer
There are two major types of lung cancer: non-small cell lung cancer and small cell lung cancer. Non-small cell lung cancer comprises 80% of lung cancers. The types of tumors included in this group include: adenocarcinoma; squamous cell carcinoma; large cell carcinoma; and bronchoalveolar carcinoma.
Delays in the diagnosis and treatment of non-small cell lung cancer can result in poorer outcomes and lower survival.
When there has been a failure to make a timely diagnose of lung cancer, the person who is most often responsible is either the primary care physician (PCP) or a radiologist.
The most frequent acts of malpractice among PCPs that result in a delay in diagnosis are: the PCP read the chest x-ray and failed to appreciate what the x-ray showed; the PCP received a report of an abnormality on an x-ray and the PCP failed to read, or appreciate the significance of, the report; or when a recognized sign or symptom receives inadequate attention. The most common symptoms of lung cancer are: a cough that does not go away; chest pain aggravated by deep breathing; hoarseness; unexplained weight loss and los of appetite; coughing up blood (haemoptysis); difficulty breathing (dyspnea); recurring bronchitis or pneumonia; or a new onset of wheezing. The most powerful risk factor for lung cancer is smoking (including second-hand exposure). In addition, certain occupations, such as those involving exposure to asbestos, uranium, arsenic, chromium, nickel, acrylonitrile, beryllium, cadmium, chloromethyl ether, silica, radon and diesel exhaust are known occupational risks for lung cancer. Family history is also a well-documented risk factor.
When a patient's history and symptoms are suggestive of lung cancer, a chest x-ray (PA and Lateral) should be ordered, along with laboratory studies (including serum calcium, alkaline phosphatase and liver function tests) and pulmonary function tests. A normal chest x-ray (or CT scan) does not exclude lung cancer. Diagnosis requires histological confirmation. Lung tissue for that purpose is usually obtained by bronchoscopy or sputum cystology.
The most frequent act of malpractice among radiologists is the failure to comment on an abnormality that appears on a chest x-ray. Simply stated, the radiologist simply failed to see the lesion that was demonstrated on the film. This occurs so frequently, that some studies have demonstrated that between 25% and 90% of lung cancers are missed when the x-ray is first read.
Another act of malpractice that frequently occurs is the failure to appropriately track an abnormality once it has been seen on an x-ray. This most often occurs in the case when a "solitary pulmonary nodule" (a relatively spherical opacity 3 cm or less in diameter) is observed on x-ray and the patient has no other significant symptoms. The generally accepted standard of care requires that a "solitary pulmonary nodule" be considered cancerous until proven otherwise.
When a health care provider's malpractice causes a delay in the diagnosis and treatment of lung cancer and that delay results in a poorer prognosis for the patient, the health care provider may be held liable for the resulting damages.
