Is “Over-Diagnosing” Cancer an Act of Medical Malpractice?

Most people believe that the earlier cancer is diagnosed, the earlier treatment can begin, which is generally a win-win situation. However, some experts say aggressive treatment of breast cancer in women over 75 might not necessarily be the right option.

According to a recent study published in the Annals of Internal Medicine, “[o]verdiagnosis is increasingly recognized as a harm of breast cancer screening, particularly for older women.” The study, which included over 54,000 women 70 years old and older who had recently been screened for breast cancer, concluded that:

• Thirty-one percent of those ages 70-74 who were screened had potentially been overdiagnosed.
• Among those aged 75-84, 47 percent of them had been potentially overdiagnosed.
• For women aged 85 and older, up to 54 percent were overdiagnosed.

The researchers concluded that whether older women should get screened for breast cancer is an individual decision, adding that overdiagnosis of breast cancer became more common as age increased and life expectancy declined.

Another study that followed 100,000 women for twenty years found that overall, patients who had been diagnosed with and treated for ductal carcinoma in situ (DCIS) had about the same chance of dying from breast cancer as those in the general population. The 20-year breast cancer mortality rate following a DCIS diagnosis was determined to be approximately 3.3 percent.

What is overdiagnosis?

Overdiagnosis is the diagnosis of a medical condition that would not have produced any symptoms or problems if it had been left undiagnosed. However, overdiagnosis often includes the detection of tumors that grow so slowly that the patient might die of old age without ever knowing the tumor exists, e.g., prostate or DCIS. As a result, a growing number of researchers and practitioners are rejecting the medical industry’s tendency to overtest, overdiagnose, and overtreat patients for conditions that might otherwise never impact their lives.

Why do physicians overdiagnose?

With the use of screening tests, the incidence of overdiagnosis has increased sharply in an effort to detect potentially curable diseases before they produce symptoms. Thanks to advancements in screenings like three-dimensional mammography, CT, MRI, and PET scanning, technology has made it easier for physicians to locate even the smallest cancers.

However, some cancers are not destined to grow or do damage due to their makeup, and aggressively treating them with surgery, radiation, or chemotherapy can be unnecessary and even harmful to patients. Instead, less-invasive surgery and the use of medications can be a viable option. In May 2023, the U.S. Preventative Services Task Force (USPSTF) released a draft recommendation encouraging women to start breast cancer screenings at age 40 and mentioning an effort to conduct more research on whether women 75 and older should be screened for breast cancer.

What are the downsides of overdiagnosis and overtreatment of cancer?

Experts say overtreatment can increase the risk for complications, cause unnecessary stress, and lead to costly and unwarranted medical bills. Although breast cancer screenings aren’t unreasonably expensive—the average mammogram costs about $100—they can prompt a series of follow-up tests and treatments that greatly inflate the cost of care. These treatments can also have serious side effects, including pain, fatigue, nausea, and damage to healthy tissues without providing any benefit to the patient’s health.

There is also a psychological impact to being diagnosed with breast cancer, and women who needlessly receive this diagnosis can be subject to unnecessary worry, anxiety, and fear regarding their health and future, which can cause them psychological harm even if the cancer is dormant and not life-threatening.

Overdiagnosis can also undermine public confidence in cancer screening programs, highlighting the risks of false positives and unnecessary interventions. This could prevent individuals from participating in recommended screening programs, potentially leading to missed opportunities for detecting and treating early-stage breast cancer.

In August 2023, an analysis of 18 clinical trials involving 2.1 million people published in JAMA Internal Medicine found that “current evidence does not substantiate the claim that common cancer screens (mammography, colonoscopy, computed tomography screening for lung cancer, fecal occult blood testing (FOBT) for colorectal cancer, and prostate-specific antigen (PSA) testing significantly prolong lives.”

The researchers concluded that although colorectal cancer screening may extend life by approximately three months, “lifetime gain for other screening tests appears to be unlikely or uncertain.”

When could overdiagnosis of cancer be considered medical malpractice?

Whether overdiagnosis of cancer constitutes medical malpractice depends on several factors, including the specific circumstances of the case and the applicable medical standards of care. Medical malpractice happens when a healthcare provider does not adhere to the accepted standards of practice in the medical community and causes harm to the patient.

In cases of overdiagnosis, medical malpractice might occur if healthcare providers:

• Fail to follow established guidelines for screening and diagnosis, leading to unnecessary tests or misinterpretation of test results.
• Neglect to consider the patient’s individual risk factors, medical history, and preferences when making diagnostic and treatment decisions.
• Provide treatment that is not indicated or appropriate based on the patient’s actual condition, leading to unnecessary harm.
• Fail to adequately inform the patient about the risks, benefits, and alternatives of screening, diagnosis, and treatment options, thereby depriving the patient of the opportunity to make informed decisions about their healthcare.

Proving medical malpractice in cases of overdiagnosis can be challenging, as it often involves complex medical judgment calls and interpretation of data. Additionally, not all cases of overdiagnosis necessarily result in harm actionable under medical malpractice law.

Patients who believe they have been harmed due to overdiagnosis should consult with a qualified medical malpractice attorney to evaluate the specifics of their case and determine if they have grounds for legal action.

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