Pittsburgh Medical Malpractice Blog

Months after a government task force rocked the medical community by changing guidelines for mammogram screening, the American Cancer Society (“ACS”) sent a similar shockwave to men. The ACS is urging doctors to make clearer to men that the test used to screen for prostate cancer (a blood test known to most as the “PSA” test) has limits and may lead to unnecessary treatments that do more harm than good.

In fairness to the ACS, it has not recommended routine PSA screening for most men since the mid-1990s. As a result, different doctors have employed different philosophical approaches to the issue of prostate cancer screening. Annually, millions of men elect to have their blood tested for the level of the prostate specific antigen. This latest position from the ACS, however, urges physicians to warn of the limitations of the PSA blood test. The ACS also offers that the digital rectal exam that has been standardly employed for as long as anyone can remember should be an option rather than part of a standard screening. Why the sudden change?

American men have long been urged to have prostate cancer screenings, but over time studies have suggested that most cancers found are so slow-growing that most men could have avoided treatment. A phrase that holds a lot of truth is that most men will die with prostate cancer not from prostate cancer. The consequences of treatment can be severe, incontinence or impotence. With the benefit of long-term data, many believe that changes are required.

The ACS is perhaps the most influential group in giving screening advice. Its new guidance on prostate cancer urges doctors to:

_Discuss the pros and cons of testing with their patients, including giving them written information or videos that discuss the likelihood of false test results and the side effects of treatment.

_Use past PSA readings to determine how often follow-up tests are needed and to guide conversations about treatment.

Prostate cancer is the most common non-skin cancer in American men. An estimated 192,000 new cases and 27,000 deaths from it occurred last year in the United States.

But prostate cancer is a slow-growing cancer in many cases, and depending on a man's age, he may be more likely to die of something else. Major studies have suggested routine screening doesn't save lives and often leads to worry and unnecessary treatment.

The new cancer society recommendations could change how routine physical exams for many older men are conducted. About 41 percent of men 50 and older get annual prostate cancer screenings. Even though the cancer society doesn't recommend routine PSA tests, many doctors do it without even asking their patients. And there's little conversation about it unless the test gives a worrisome result. The new guidelines may spur doctors to talk to their patients earlier about the pros and cons of getting the test in the first place.

Prostate cancer screening became a medical mantra in the 1990s, thanks to the development of the PSA test. Some celebrities became advocates for routine testing, including former New York City Mayor Rudy.
But concerns about the value of routine screening increased after two large studies concluded screening for prostate cancer doesn't necessarily save lives, and noted any benefits can come at a high price.

The American Urological Association - a longtime proponent of regular screening – has backed off its call for annual tests after age 50. The group said men should be offered a baseline PSA test at age 40, with follow-ups at intervals based on each man's situation.

The group also has stood by the rectal exam as a standard part of screening, saying it can find cancer that the blood test does not.

The cancer society has been more cautious about regular screenings for some time. The organization last issued guidelines in 2001, which said merely that doctors should offer screening and discuss the risks and benefits.
The new guidelines back away even more, dropping the sentence that doctors should offer prostate screening. Instead, the society says some evidence indicates periodic screening can save lives but that there are significant uncertainties about the overall value of finding prostate cancer early. Screening should not take place, the new advice says, unless a patient is fully informed of the trade-offs.

Men at average risk should get detailed information around age 50, the society recommends. Men at higher risk, including African-Americans and men with a father or brother who had prostate cancer before age 65, should get the information beginning at age 45. Men with more than one close relative with prostate cancer before 65 should get such information at age 40.

For men who want to be screened regularly, the new guidelines recommend every other year if the PSA reading is less than 2.5, a measure of prostate specific antigen per milligram of blood. Annual tests are recommended for 2.5 or higher and a 4 suggests consideration of a biopsy.

This is a difficult issue with no clear conclusion to be drawn. Individual doctors will react to these recent guideline changes in different ways. Similarly, individual patients may react to the guideline changes and recent study results in different ways as well. For now, men should know there is a controversy here and discuss the controversy with their doctor. For what it is worth, the lawyers at Rosen Louik & Perry have handled numerous cases and obtained impressive verdicts and settlements in situations where prostate screening and treatment were provided at an unacceptable level. If you believe that you or a loved one may have received inadequate medical care, please call for a free consultation.

A recent study found that colonoscopies, once thought to be an infallible way to detect colorectal cancer, may miss many cancers. A Canadian study published in the Annals of Internal Medicine in December reported that a colonoscopy may miss a type of polyp, a flat or serrated lesion or an indented one that rests against the colon wall. While colonoscopies are still recommended as a highly effective way to diagnose and prevent colon cancer, the test is much less accurate than previously thought.

In the study, colonoscopies missed nearly every cancer in the right side of the colon, where about 40 percent of cancers develop. It also missed about one third of cancers in the left side of the colon. While doctors once told patients colonoscopies can prevent 90 percent of cancers, they may actually prevent only 60 or 70 percent.

One thought is that the Canadian doctors in the study may not have been skilled enough to perform the procedure. One third of the tests were done by general internists and family practitioners. This makes it important for patients to be proactive in ensuring the quality of their colonoscopists. They need to make sure they have adequate experience. Patients should also ask questions about how many polyps are found and removed and should also report symptoms like bleeding, even if they occur soon after the procedure.

Your colonoscopist should make sure that the bowels are sufficiently cleansed and that there is just a short time between when patients finish taking the strong laxative that cleanses their bowel and the colonoscopy.

Doctors should find polyps in at least 25 percent of men and 15 percent of women. They should take at least eight minutes to withdraw an endoscope from the colon. And they should do a high volume of screening.

About 148,000 people will be diagnosed with colon cancer this year, the American Cancer Society reports, and 50,000 people will die from it. Medical malpractice and misdiagnosis may be responsible for some of these deaths. Contact the medical malpractice lawyers at Rosen Louik & Perry to schedule a free consultation.

October is National Breast Cancer Awareness Month. Prevention and early detection is the key to surviving breast cancer. According to the American Cancer Society, breast cancer is the most common cancer among women with the exception of skin cancers, and the second cause of cancer deaths for women. If detected early, there is a 98 percent chance of a five-year survival. However, only approximately 22% of women are diagnosed early.

Although there are several risk factors that may increase your chance of developing breast cancer, including age, personal or family history, alcohol use, obesity and ethnic background, it is important to note that just because you may have a risk factor for breast cancer doesn't mean you will contract the disease. There are some things you can do to lower your risk for developing breast cancer, such as eating healthy, exercising and limiting your alcohol consumption. However, early detection is key to surviving the disease.

So what can you do to assist in the early diagnosis of of breast cancer?

·Get a mammogram. All women ages 40 and older should have an annual mammogram and clinical breast examination.
·Women in their 20’s and 30’s should have a clinical breast exam at least once every three years.
·Perform a monthly self-breast examination. For women ages 20 and older this must be a monthly routine.

Sometimes, even when you take all the proper measures to reduce your risks, a misdiagnosis or delayed diagnosis of breast cancer by a medical professional can still occur. If you or a loved one has breast cancer, you should consider discussing your case with one of our skilled Pittsburgh, Pennsylvania medical malpractice lawyers. At Rosen Louik & Perry, P.C. our Pittsburgh medical malpractice lawyers and staff can determine whether there has been either a failure to diagnosis or a delayed diagnosis of breast cancer. Our on-staff medical doctors know what questions to ask to quickly determine whether you or your loved one is the victim of medical malpractice. Contact our law firm today for your FREE consultation.

At some point, we have all relied on and trusted the skill, education, and experience of a physician to diagnose and treat an illness or injury. Most of the time, our trust is well placed. On occasion, however, physicians make mistakes. A set of symptoms can be overlooked, an x-ray is misread, or the physician is too busy to take the time to listen to the patient’s complaints. Such incidents can cause devastating delays in treatment. In cases involving cancer, the delay can allow the disease to progress to stages that are incurable, and can mean the difference between life and death. Statistics show that around 40% of all medical malpractice claims result from the failure of medical personnel to diagnose a significant disease process.

Some of the most serious diseases and/or conditions have insignificant symptoms and cause no major discomfort in early stages. Unfortunately, some of the most serious diseases are often the ones that go undetected for long periods of time. Listed below are some of the diseases/conditions that frequently are not diagnosed in a timely fashion:

Ovarian cancer
Prostate cancer
Cervical cancer
Breast Cancer
Pulmonary embolism
Appendicitis
Bacterial meningitis
Heart Attack
Stroke

If you or a family member is suffering from a condition due to the healthcare professional's failure to diagnose, please contract Rosen Louik & Perry, P.C. Failure to diagnosis and/or a misdiagnosis constitutes negligence and the innocent victim of such negligence deserves compensation for the resulting financial burdens and pain and suffering. A medical malpractice claim can be very complicated and only a lawyer that is experienced with medical malpractice cases can properly prosecute your claim. Our attorneys have years of experience with failure to diagnose cases. At Rosen Louik & Perry, P.C. we fully understand the complexities involved in evaluating medical malpractice cases. For over 15 years, we have employed two full-time medical doctors who assist us in evaluating medical malpractice cases. Contact us today for your FREE consultation.