errors are more common than the public realizes. A comprehensive report by
the National Academy of Sciences1 (December 1999) revealed that
between 45,000 and 98,000 Americans die each year as a
direct result of many kinds of medical errors.
This report prompted President Clinton to sign an executive order on
December 7, 1999, launching a major Federal initiative (Agency for
Healthcare Research and Quality) to reduce medical errors and improve
Up to 9.5% of surgical pathology cases received a major change in
diagnosis leading to significant revisions in treatment and
prognosis. This figure-published in the prestigious medical journal
Cancer-- comes from a recent study (December 1999) at Johns
A University of Utah Medical School survey4 (February
2000) found a significant biopsy diagnostic disagreement rate of 2%
A review5 of surgical pathology cases found a
major error rate of 1.2%.
Judging by medical malpractice claims6, breast
cancer patients are the most likely to encounter errors in the
detection and diagnosis of their disease.
The Most Commonly Encountered Errors in Surgical Pathology
(Biopsy) Diagnosis of Cancer include:
A mass that is actually benign (non-cancerous) is
incorrectly called malignant (cancerous).
A tumor that is really malignant is erroneously called
A cancer (malignant tumor) is correctly identified but assigned
an inaccurate classification (type) or grade (aggressiveness).
A cancerous lesion is missed (inadequately sampled) by the
A specimen-- which contains cancer-- is incompletely sampled or
prepared by the pathology department, causing the cancer to be
undetected by the pathologist.
three situations can be detected by a second opinion review of the
microscopic (glass) slides. The last two scenarios, however, require an
alert clinician to be suspicious of cancer.
Errors in the Biopsy Diagnosis of Cancer can
Unnecessary or incorrect cancer treatment (surgery,
chemotherapy, radiation) with serious complications or long-term
disability when a benign lesion is incorrectly diagnosed as
A missed opportunity to treat a curable cancer-- especially
when an early malignant lesion is incorrectly diagnosed as non-cancerous
or inadequately sampled.