Delayed Diagnosis of Colorectal Cancer and Iron Deficiency Anemia

By Margot Heffernan, MLS

Colorectal cancer is the third most common type of non skin cancer that is diagnosed in both men and women in the United States. The American Cancer Society estimates that there will be 143,460 new cases of colorectal cancer diagnosed in 2012. Although the death rate for this cancer has been steadily dropping in both men and women over the past twenty years, it is still the second leading cause of cancer related deaths in the U.S. Colorectal cancer is expected to claim 51,690 lives in 2012.

Colorectal cancer is also one of the most common diagnoses cited in malpractice related claims. Although the trend toward earlier diagnosis coupled with advanced chemotherapeutic treatment modalities have lead to decreased mortality for colorectal cancer, there are still cases of delayed diagnosis that result in legal action against the physician. Multiple studies have shown that diagnosis of colorectal cancer at an early, localized stage leads to a significantly longer survival rate for such patients. Failure to diagnose colorectal cancer in its early, more treatable stages is a primary factor in many medical malpractice claims.

Although the terms medical malpractice and negligence seem like familiar and straightforward concepts to the lay public, the actual events that lead up to a medical malpractice claim are frequently a complex set of issues that encompass patterns of patient behavior, physician attitudes, as well as the biology of specific tumors.

One reason frequently cited as a factor in colorectal cancer litigation is the concept of delayed diagnosis. This concept has been presented in both the medical and legal literature and is generally divided into two broad categories:

• Patient delay-This refers to any reason why the patient decides not to seek medical advice after the onset of a particular symptom or symptoms.
• System delay- System delay can include a wide array of factors, such as an actual misdiagnosis by the physician or the failure of the physician to order appropriate tests to determine a correct diagnosis.

System delay can be the result of a specific symptom or sign that is overlooked by the physician. It is what leads to medical malpractice claims in many cancer related cases. Because the symptoms of colorectal cancer are often nonspecific, the physician must carefully evaluate each complaint within the context of  the individual case. Certain symptoms may point to a very benign problem in some subsets of patients, while the very same sign might be a red flag for a more ominous diagnosis like colorectal cancer in other groups.

One of the most overlooked clues to an early diagnosis of colorectal cancer in older patients (over the age of 60) is a finding of iron deficiency anemia (IDA). IDA is a blood disorder that is defined as having an inadequate number of healthy red blood cells. It is the most common type of anemia and may be caused by multiple factors, including lack of iron in the diet or a  blood loss through the gastrointestinal tract.

IDA is a common finding in premenopausal women because of blood loss through menstruation. However, IDA that occurs in postmenopausal women and in men is a much more suspicious finding for chronic gastrointestinal bleeding. Gastrointestinal bleeding can be caused by ulcers, intestinal polyps, or colorectal cancer. Sometimes IDA is discovered incidentally as part of a routine blood study.  When this happens, and there are no additional symptoms associated with colorectal cancer, the primary care  physician might not initially suspect this disease. In fact, the failure to refer such a patient to a gastroenterologist at this juncture is the main reason for a delayed colonoscopy. Since colonoscopy is the standard and definitive procedure for diagnosis of colorectal cancer, failure to proceed with this test equals a failure to diagnose colon cancer. When the breakdown in the diagnostic process occurs at this point, a colorectal cancer diagnosis might not be made until the patient has a more advanced stage of disease.

Delayed diagnosis of colorectal cancer is a common reason for diagnostic malpractice claims. Failure of the primary care physician to refer an older patient with IDA to a gastroenterologist can cause a significant lag time between findings of IDA and  a diagnosis of colorectal cancer.

For more information on colorectal cancer or colorectal cancer litigation, please contact  Heffernan Research.