Medical and legal implications of screening and follow-up procedures for breast cancer

Grievances result from false expectations on the part of both practitioners and patients when a disease treatment problem is unsolved because of biological variations in the disease itself. Widely publicized screening and follow-up recommendations are often the source of the grievances. Even when recommendations are followed exactly, bad outcomes are still associated with incurable cancer even though a fatal outcome is inevitable. Patients must be told about treatment prospects including limitations of efficacy, so that patient expectations will be realistic. Otherwise, practitioners may find themselves involved in lawsuits alleging deviation from case standards for an adverse outcome actually attributable to the nature of the cancer. Because screening and follow-up techniques continue to control treatment of breast cancer, such lawsuits are common. When ineffective treatment exists, there often are adverse harm/benefit considerations and high costs, particularly when screening or follow-up are practiced defensively, without hard data proving the value of a strategy. This article will review these problems, placing specific emphases on screening and follow-up procedures and on strategies for breast cancer. Factors that limit efficacy and increase both cost and diagnosis-associated morbidity will also be explored.