Breast Lump Evaluation: the Triple Assessment Protocol

Be aware that breast lumps are treated in a different fashion from doctor to doctor. This inconsistency is very conducive to a patient becoming a victim of a late diagnosis of breast cancer, when there is a much higher rate of dying.

Failure to diagnose breast cancer has been the leading or second most common reason for malpractice suits in recent years.

Many people believe that if they have a breast lump and the mammogram is normal or negative then they’re fine. Nothing could be farther from the truth. Mammograms are only 70 to 85% accurate in diagnosing cancer in women with a breast lump.

If you have a breast lump and a normal mammogram or ultrasound, be aware that a third tool is available to help make the right diagnosis, and that tool is a needle biopsy.

When you add the needle biopsy to the mammogram and the clinical breast exam, experts call this the “triple assessment protocol,” and many believe that this is necessary for you to have the best chance at an early diagnosis of breast cancer.

Too many mothers, daughters, wives, sisters and friends have died from breast cancer that could have been diagnosed and treated if it had been caught earlier. Don’t let that happen to you.

“We found that a substantial proportion of women with a breast problem managed by generalists did not receive care consistent with a clinical guideline, particularly younger women with a clinical breast complain and a normal or benign-appearing mammogram.”1

“Problems with breast cancer can include underuse of mammography for early cancer detection, lack of adherence to standards for diagnosis, inadequate patient counseling regarding treatment options, and underuse of radiation therapy and adjuvant chemotherapy following surgery.”2

“Mammography screening is far from perfect. Mammography does not depict all cancers.”3

“Every radiologist who has any long-term experience has failed to perceive something of importance that is visible in retrospect. All radiologists, no matter how skilled or dedicated, cannot avoid periodically missing a clinically important lesion.”3

Studies, Footnotes and Resources:

  1. Haas, Jennifer S., E. Francis Cook, Ann Louise Puopolo, Helen H. Burstin, and Troyen A. Brennan. “Differences in the Quality of Care for Women with an Abnormal Mammogram or Breast Complaint.” Journal of General Internal Medicine 15 (2000): 321-328
  2. Institute of Medicine. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, D.C.: National Academy Press, 2001, p.24.
  3. Kopans, Daniel B. Editorial: “Mammography Screening is Saving Thousands of Lives, But Will it Survive Medical Malpractice?” Radiology 230(1) (2004): 20-24.