Delayed Diagnosis of Lung Cancer

Investigating a Delay in Diagnosis of Lung Cancer Case

Lung cancer is a dreaded diagnosis.  The significant risk of lung cancer associated with cigarette smoking is well-known and real.  Prevention of lung cancer starts with smoking cessation.  Yet, while doctors can’t entirely prevent the behavior which often leads to lung cancer, doctors can offer patients hope for cure or prolonged survival by the early diagnosis and treatment of lung cancer.

At Lupetin and Unatin, we can unravel whether you or your loved one were the victim of a delayed diagnosis of lung cancer.  We also know how to answer the pivotal question in every case based on cancer misdiagnosis: did the delay in diagnosis make a meaningful difference in the outcome for the patient?

Opportunity for Earlier Diagnosis

As part of their initial work-up for a new cancer patient, an oncologist will look at older chest CT scans or chest x-rays, only to discover the signs of lung cancer were present many months or years before the diagnosis was finally made.  The diagnosis of lung cancer is even more devastating when a patient and their family learn their lung cancer should have been diagnosed when tumors were smaller and before the cancer spread throughout the body.  

Every investigation into a potential lawsuit related to misdiagnosis of lung cancer involves obtaining and reviewing medical records and imaging studies.  But before that, we conduct an in-depth interview with the patient or their loved one.  We ask questions to learn as much as possible about the patient’s past visits to their doctor, medical specialists, or hospitals.  The medical history is where we look first to find out whether an opportunity to diagnose cancer at an earlier stage was missed. 

Important questions we must answer include:

Was the patient was repeatedly telling his doctor or emergency room staff about symptoms concerning for a potential lung malignancy like bloody cough or shortness of breath?

Was the patient admitted to the emergency department or hospital for a sudden illness or injury? If so, did the patient undergo a chest x-ray or CT scan which showed a lung mass that was missed or not reported to the patient’s doctors?

What do the films show?

In some cases, you do not need to be a radiologist to see something on a chest x-ray or CT scan which is clearly abnormal.  Nonetheless, if a radiologist may have overlooked concerning radiology findings like a lung nodule or mass, we need to consult a radiologist to look at those images. 

We make sure the radiologist who reviews the imaging does a “blind read” of the images.  This means our expert will review the radiographic images without the benefit of knowing what the treating radiologist described in the written report of the CT, X-ray, or other radiology study.  A blind read is the best way to be sure our expert doesn’t look at the radiology study with a particular diagnosis in mind, and subconsciously skew their interpretation of the study towards a particular finding.  By asking for a blind read, our goal is to put our expert in the same position as the radiologist who may be the defendant in a lawsuit.  This is only fair to the radiologist who may have misinterpreted the imaging study, yet never had the benefit of knowing what he or she missed.

Would Earlier Diagnosis Make a Difference?

To bring a successful medical malpractice lawsuit, it is not enough to prove lung cancer should have been diagnosed months or years earlier.  We must present medical testimony to show the cancer should have been diagnosed at an early stage before the cancer had an opportunity to grow or spread to other parts of the body like the lymph nodes or distant organs.  Sadly, a lost opportunity to diagnose lung cancer at an earlier stage can mean several years of a life lost for a mother, father, daughter, son, mother, or father. 

Lung cancers are divided into several subtypes with different characteristics related to how fast the cancer grows and spreads to other parts of the body.  Not all lung cancers are equal in terms of how easily they can be treated with surgery, chemotherapy, or radiation. 

The biggest questions we must answer before filing a lawsuit are:

1. When was the first opportunity to diagnose lung cancer?
2. Based on the specific type of lung cancer diagnosed, could the patient have received less harmful or intense treatment if their lung cancer was diagnosed months or years earlier?
3. What is the prognosis for a patient who has this specific type of lung cancer diagnosed at an earlier stage, and how did diagnosis of the cancer at a later stage affect the patient’s prognosis?
4. How did the delay in diagnosis affect the patient’s likelihood of beating their lung cancer for at least five years, or even ten years?

 To answer these questions, we focus on critical tests like CT scans.  If a lung mass was overlooked on a CT scan performed in 2017 and not diagnosed until a second CT scan was performed in 2019, we can ask an expert in radiology to measure the size of each mass to determine how much the mass grew during the two-year delay in diagnosis.

We must also review reports from pathologists who examine biopsies of cancerous lung tumors and lymph nodes.  Microscopic examination of the cancer after it is removed from the body is critical to understanding the lung cancer subtype and determining the stage of cancer.  Other radiology tests like PET scans performed with radioisotopes can detect the most subtle signs that the cancer has spread to other parts of the body. 

With tests like those described above, we can answer questions like how many areas of the body are involved with metastasis. Or is lung cancer confined to the region around the lungs? Ultimately, we need to hire an oncologist to review all of these records and tell us whether, in their professional opinion, earlier diagnosis would have caught lung cancer at an earlier stage with a much better prognosis for the patient. 

In some cases, it is impossible to know for sure how advanced a patient’s cancer was years earlier when it should have been diagnosed. But by working backwards, and with the help of experts who help us understand how quickly different types of lung cancer grow, we can determine whether the delay significantly increased the risk of harm to the patient.

What was the opportunity missed?

Various types of mistakes can lead to delays in diagnosis of lung cancer.  As referenced above, lung nodules or masses may have been missed on radiology studies.  Delays in diagnosis can also involve the failure to order radiology studies for patients with clinical signs or symptoms of lung cancer and risk factors like smoking.  Symptoms of potential lung cancer include chronic cough, coughing blood, shortness of breath, chest pain and anemia.

Who is responsible for the delay in diagnosis of lung cancer?

Identifying who is responsible for a delay in diagnosis of lung cancer can be challenging.  A single doctor may deserve the entire blame for a delay in diagnosis.  In other cases, more than one health care provider may have failed to do their part to detect or properly communicate signs of potential lung cancer.

 In cases involving missed findings on a chest CT scan or a chest x-ray, we assume the ball was dropped by the radiologist who interpreted the test, the physician who ordered the study, or both.  Our investigation of the records starts with the images from the radiology test and the report of the radiologist who interpreted the test.  Did the radiologist fail to report, and presumably fail to see, a suspicious lung mass? Or did the radiologist see and report a suspicious lung mass, but the ordering physician failed to make sure the patient underwent further testing like biopsy to confirm or rule out lung cancer?

To learn more about various errors in interpretation and communication of radiology results which can impact the diagnosis of lung cancer, click here.

Failure to Screen for Lung Cancer

Many people who reach a certain age and our recent smokers are at increased risk for lung cancer.  Primary care doctors should consider whether patients should undergo annual screening with low-dose CT scanning which can detect cancer at an earlier stage.

There are several factors doctors should consider when deciding whether to recommend annual lung cancer screening.  Physician groups like the American College of Chest Physicians and the National Comprehensive Cancer Network set out guidelines to help doctors decide when to discuss lung cancer screening with their patients.  The most important factors in this decision are the patient’s age, how much they smoke (or smoked) and for how long.  The patient’s underlying health is another important factor in the decision whether a patient should undergo screening for lung cancer. Smoking often leads to severe cardiovascular disease and increases the risk for other illnesses other than just lung cancer. Frankly, these potentially life-threatening conditions could be more of a threat than lung cancer and therefore make the benefit of lung cancer screening lower than the risks.

But lung cancer screening with low dose CT scanning can still save lives of those with lung cancer.  Earlier diagnosis makes cancer treatment less invasive and harmful to the patient.  Earlier diagnosis may mean a smaller portion of the lung will need to be removed in order to remove all of the cancer.  More importantly, earlier diagnosis generally means a better chance for longer survival with lung cancer.[1] 

[1] Black WC, Chiles C, Church TR, et al; National Lung Screening Trial Research Team. Lung cancer incidence and mortality with extended follow-up in the National Lung Screening Trial. J Thorac Oncol. 2019;14(10):1732-1742.