Medico-legal aspects of delay in breast cancer diagnosis: the radiologists' perspective

The increasing importance of breast imaging in the diagnosis of breast problems and the use of mammography in screening now mean that breast radiologists are very much in the front line for medico-legal action. Breast imaging is now the commonest reason for a radiologist to be involved in medico-legal investigations. The reason is almost always an alleged delay in diagnosis. In symptomatic practice this usually involves alleged failure to carry out the appropriate imaging investigation, including image-guided biopsy, while in screening practice this usually involves failure to detect the early signs of breast cancer. These arise out of the unrealistic expectations of patients about the diagnosis of breast cancer. Measures to reduce the risks of medico-legal investigation are simple and straightforward.

Recent emphasis on informed consent by the GMC means that radiologists, like all others involved in patient care, are required to provide patients with the full facts on which these patients can base their decisions. It is important to ensure that the radiological aspects of care are formally documented, including the content and results of discussions at multidisciplinary meetings.

The Bolam test increasingly cannot be considered an adequate defence; if the court considers it bad practice then it does not matter how many doctors practice the same way. However, both symptomatic and screening practice are now the subject of detailed clinical protocols; provided these are in place and are strictly followed, then proof of substandard care is difficult. In addition, double reading is now largely standard practice in screening and there is a wealth of data to inform medico-legal investigations about the limitations of screening practice.