Oncology Expert Discusses Insufficient Follow-Up Testing in Breast Cancer Patient

This case involves a middle-aged female patient with a previous history of lymphatic cancer that had been treated successfully. Years after successfully undergoing treatment for this first cancer, she was diagnosed with Stage III breast cancer. In the course of her treatment, she underwent a mastectomy, as well as several rounds of chemotherapy. Despite this treatment, she was diagnosed again with Stage IV breast cancer some years later, with observed metastases in her bones and lymph nodes. Without looking at the results of a new biopsy, her oncologist started her on the same treatment she had for breast cancer originally. After obtaining a second opinion, the patient discovered that her cancer would not respond to this treatment, and that she should have been on an entirely different selection of drugs.

Question(s) For Expert Witness

Expert Witness Response E-061928

As a surgeon I do treat recurrent breast cancer, but this is a small proportion of my cases. After her original treatment, we would typically follow the patient with clinical exams. The National Comprehensive Cancer Network guidelines make surveillance recommendations and we, in accordance with the guidelines, do not usually use routine imaging studies for surveillance in the absence of signs or symptoms that require evaluation. The mistake in her case lies with failure of her team to assess the biopsy of her recurrent breast cancer. The type of tumor should be rechecked (and again this is also in the NCCN guidelines) as the recurrent tumor may be different and need different treatment. Her survival would likely have been longer if her recurrent disease was truly HER2 positive and she had received targeted therapy. In practice we do see cases where repeat biopsies change the treatment recommendations.

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