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Cancer Misdiagnosis- Second Opinion?

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According to the research linked and excerpted below, the rate of cancer misdiagnosis is 11.1%. This finding varies by type of cancer but 11% is a reasonable percentage to use for this blog post.

I am not writing this post to criticize oncology. Diagnosing cancer in the human body can be difficult.  I’m simply making the point that newly diagnosed cancer patients should be aware that they should get a second opinion to confirm their diagnosis of cancer.

For every 1000 people reading this post, approximately 110 of them will experience a cancer misdiagnosis. That is a lot of anxiety, fear, depression, etc. that didn’t need to happen.

Multiple Myeloma Stem Cell Transplant

I was diagnosed with a type of pre-cancer called single plasmycytoma of bone in early 1994. Less than 12 months later my SPB became full blown multiple myeloma. I’m confident that my my diagnosis of a SPB was a misdiagnosis. I’ll never be able to prove this and I had no idea what was going on at the time.

A second opinion may have exposed Dr. Berger’s misdiagnosis and started my therapy plan a year earlier.

Are you a newly diagnosed cancer patient? What type of cancer? What symptoms are you experiencing? Let me know- David.PeopleBeatingCancer@gmail.com

Thanks

David Emerson

  • Cancer Survivor
  • Cancer Coach
  • Director PeopleBeatingCancer

Rate of diagnostic errors and serious misdiagnosis-related harms for major vascular events, infections, and cancers: toward a national incidence estimate using the “Big Three”

“Results– Rates for the 15 diseases were drawn from 28 published studies representing 91,755 patients. Diagnostic error (false negative) rates ranged from 2.2% (myocardial infarction) to 62.1% (spinal abscess), with a median of 13.6% and an aggregate mean of 9.7%.

Serious misdiagnosis-related harm rates per incident disease case ranged from 1.2% (myocardial infarction) to 35.6% (spinal abscess), with a median of 5.5% (IQR 4.6–13.6) and an aggregate mean of 5.2%. Rates were considered face valid by domain experts and consistent with prior literature reports.

Conclusions

Diagnostic improvement initiatives should focus on dangerous conditions with higher diagnostic error and misdiagnosis-related harm rates…

Overall diagnostic error rates in real-world practice are not known, but a commonly cited estimate based on expert opinion is that 10–15% of all rendered diagnoses are incorrect [2]…

Table 5:

Severity-weighted, disease-specific diagnostic error and serious misdiagnosis-related harm rates.

Cancer
 Lung cancer 22.5% (PR: 11.4–37.8) 2.01 61.9% (56.8–67.2) 13.9% (7.0–23.6)
 Melanoma 13.6% (PR: 6.8–25.0) 1.34 41.2% (37.8–44.8) 5.6% (2.8–10.3)
 Colorectal cancer 9.6% (PR: 8.4–47.7) 1.87 57.4% (52.7–62.4) 5.5% (4.8–27.6)
 Breast cancer 8.9% (PR: 8.5–26.3) 1.61 49.4% (45.3–53.7) 4.4% (4.2–13.1)
 Prostate cancer 2.4% (PR: 1.7–13.8) 1.70 52.2% (47.9–56.7) 1.2% (0.9–7.3)
 Top 5 cancers subtotal 11.1% (PPR: 10.1–20.9) 1.82 56.0% (52.3–58.8) 6.2% (5.5–11.7)
 Other cancers 11.1% (PPR: 10.1–20.9)b 2.13 65.5% (60.1–71.1) 7.3% (6.6–13.9)
 Total cancers 11.1% (PPR: 10.1–20.9) 1.95
Table 3:

Literature-derived missed or delayed diagnosis rates for the top 5 cancers- cancer misdiagnosis.

Cancer Point estimatea Lower bound Upper bound Study design (sample) Notes
Lung cancer 22.5% [58] 11.3% [59] (PB % with long delayb) 37.8% [60] (PB % with any delayb)
  1. National registry study (n=32,441) [58]

  2. Interview study (two states, five centers or clinics; n=275) [59]

  3. Retrospective cohort study (2 medical centers; n=587) [60]

  1. NCI SEER Database 2003–2006 linked to Medicare; 12 registries representing nine states, 14% of US population; guideline-discordant delays 22.5% (n=7302), almost entirely due to diagnostic delay

  2. Two-state, five cancer centers/clinics, direct patient interviews; 11.3% (n=~31/275) perceived diagnostic delay and took >90 days to treatment

  3. Two Department of Veterans Affairs (VA) medical centers in the US; 587 new pathologically diagnosed lung cancers 2004–2007; dual independent review of charts; 222 judged to have ≥1 missed diagnostic opportunity

Breast cancer 8.9% 8.5% (95% CB) 26.3% (PB % with short delayb) National registry study (n=21,818) [61] National Cancer Comprehensive Network (NCCN) Breast Cancer Outcomes Database 2000–2007; eight US comprehensive cancer centers; delay >60 days in 26.3% (n=5747) and >180 days in 8.9% (n=1937)
Colorectal cancer 9.6% [62] 8.4% [62] (95% CB) 47.7% [63] (PB % with short delayb)
  1. National registry study (n=10,663) [63]

  2. Retrospective cohort study (single, large health plan/system; n=2191) [62]

  1. NCI SEER Database 1998–2005 linked to Medicare; 12 registries representing nine states, 14% of US population; delay ≥60 days in 47.7% (n=4614/9669)c

  2. Two divisions of a single large health plan/system (Kaiser Permanente Northern and Southern California); 50–70 year olds, 2010–2014 (n=70,124), with a positive screening fecal immunochemical test for colorectal cancer followed by diagnostic colonoscopy; 2191 found to have colorectal cancer; delay ≥10 months in 9.6% (n=211)

Prostate cancer 2.4% 1.7% (95% CB) 13.8% (PB % with short delayb) National registry study (n=1763) [64] UK Clinical Practice Research Datalink 1998–2009; 600 primary care practices, 7% of UK population; delay despite red flag symptoms >1 month in 13.8% (n=244) and >6 months in 2.4% (n=42)
Melanoma 13.6%d 6.8% [65] (PB % with long delayb after told “all clear”) 25.0% [66] (PB % with short delayb)
  1. Population-based interview study using registry data (n=3772) [65], [66]

  2. Retrospective cross-sectional chart review study (n=933)d

  1. Population-based telephone survey in Queensland, Australia for patients diagnosed with invasive melanoma 2000–2003 in the Queensland Cancer Registry; post-presentation (first physician to definitive diagnosis) delay times of >6 weeks in 25% [66]; delay >3 months after first physician said either “watch it for a while” (6.9%) or “all clear” (6.8%) in a combined 13.7% [65]

  2. Cross-sectional study (2009–2015) at a single, US-based academic center; 933 pathologically proven melanomas (591 pigmented, 342 amelanotic); chart review ~156 clinically misdiagnosed, ~82 pathologically misdiagnosedd

Table 5:

Severity-weighted, disease-specific diagnostic error and serious cancer misdiagnosis-related harm rates.

Cancer
 Lung cancer 22.5% (PR: 11.4–37.8) 2.01 61.9% (56.8–67.2) 13.9% (7.0–23.6)
 Melanoma 13.6% (PR: 6.8–25.0) 1.34 41.2% (37.8–44.8) 5.6% (2.8–10.3)
 Colorectal cancer 9.6% (PR: 8.4–47.7) 1.87 57.4% (52.7–62.4) 5.5% (4.8–27.6)
 Breast cancer 8.9% (PR: 8.5–26.3) 1.61 49.4% (45.3–53.7) 4.4% (4.2–13.1)
 Prostate cancer 2.4% (PR: 1.7–13.8) 1.70 52.2% (47.9–56.7) 1.2% (0.9–7.3)
 Top 5 cancers subtotal 11.1% (PPR: 10.1–20.9) 1.82 56.0% (52.3–58.8) 6.2% (5.5–11.7)
 Other cancers 11.1% (PPR: 10.1–20.9)b 2.13 65.5% (60.1–71.1) 7.3% (6.6–13.9)
 Total cancers 11.1% (PPR: 10.1–20.9) 1.95

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