Posted: August 8, 2012

A fifty-four year old woman was being followed by her gynecologist for routine visits.  She had previously been treated for bilateral breast cancers successfully and had a strong family history of breast and ovarian cancer.  She was seen from time to time by one of her doctor’s partners if he happened to be out of town.  During one of those visits, based on her personal and her family history, the partner suggested she have genetic testing for the BRCA1 and 2 mutations, inherited conditions that predispose a woman to a high likelihood of getting breast and ovarian cancer as well as other cancers; and/or removal of her ovaries and uterus.  She refused. There was a factual dispute about whether the partner ever mentioned the potential value of having her ovaries removed prophylactically so as to prevent her from ever getting ovarian cancer.  There was a somewhat vague note in the chart about this issue, and the doctor and the patient had different recollections.  According to her office chart her original gynecologist never mentioned either testing or surgery, although later on he couldn’t believe he had not.

Two years later she began having lower abdominal pain. A CT scan showed a complex ovarian mass.  She underwent surgery by yet another gynecologist in the same group – at which time he removed a large ovarian cancer that ruptured at the operation.  She was started on chemotherapy after the surgery to try to prevent further spread of disease that might have been too small to see at the operation, but after two chemo treatments she sought a second opinion from a gynecologist who specialized in the treatment of gyn cancers, a so-calledgynecologic oncologist.  He insisted on re-operating because he said that the original operation was not thorough enough.

In fact, most general gynecologists do not even attempt surgery on a woman strongly suspected of having ovarian cancer. At his deposition, the operating gynecologist stated that, despite the patient’s formidable personal and family history, he did not suspect cancer.  At the second surgery, in which much additional tissue was removed, no further cancer was uncovered. She finished her chemo and has been fine ever since.  She eventually acquiesced to testing for the BRCA mutations and tested positive for BRCA 2.

+ Read the entire blog post and Dr. Stark’s feedback on the court case on the BS757 Health Blog.