title: Diagnostic delay of breast cancer - an analysis of claims to Swedish Board of Malpractice (LÖF).
abstract: OBJECTIVE
  Delay in the diagnosis of breast cancer may have important clinical and medico-legal implications. This study examined the decisions made by reviewers at the Swedish agency (LÖF) that handles claims of medical malpractice where claimants seek compensation for alleged suffering and/or negative clinical impacts of diagnostic delays.
  
  
  METHODS
  In 1995-2006 a total of 134 women filed claims for negative effects resulting from delays in the diagnosis of breast cancer. Review of the claims led to approval of delay in the primary diagnosis for 62 women and of recurrence for 28 women. The clinical symptoms that were overlooked and other causes of delay that had any relation to therapy, prognosis and economic compensation were identified. The verdicts reached were analysed.
  
  
  RESULTS
  The median delay in the diagnosis of the primary disease was 11 months and for recurrent disease 3.5 months. Delay in diagnosis of the primary disease was considered to have an impact on the therapy in 23%. The prognosis was postulated to have been adversely affected 11% of the patients for whom the delay was longer than 12 months. Delay in diagnosing the recurrence was contributing to delay in starting therapy and to unnecessary suffering in 32%. The delay in diagnosis was mainly caused by incomplete clinical or radiological examination and by misinterpretations of the examination results. Economic compensation was given in 90%. There was a warning or admonition to the responsible doctor in a third of the cases referred to the judgement court.
  
  
  CONCLUSIONS
  This study demonstrates that claims for compensation for delay in diagnosis of breast cancer in Sweden occur in about 1/1000 new patient. The delay in the diagnosis of the primary tumour was considered to have an impact on the magnitude of therapeutic measures in almost 25% of the women who filed claims. Economic compensation for the patients' injuries was given in ninety percent of the cases. In women for whom there was a delay in diagnosing the recurrence there was consequently a delay in starting the palliative therapy.
authors.affiliation: Department of Surgery, Sahlgrenska University Hospital, Göteborg, Sweden. lo.hafstrom@surgery.gu.se
authors.forename: Larsolof
authors.initials: L
authors.lastname: Hafström
authors.forename: Henry
authors.initials: H
authors.lastname: Johansson
authors.forename: Jon
authors.initials: J
authors.lastname: Ahlberg
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000401:mortality / Q000473:pathology; D035881:Compensation and Redress / Q000331:legislation & jurisprudence; D057210:Delayed Diagnosis / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008318:Malpractice / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis* / Q000401:mortality / Q000473:pathology; D012042:Registries; D013044:Specialty Boards; D013548:Sweden