This Article Full Text Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Save to my personal folders Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Singh, H. Articles by Petersen, L. A. Search for Related Content PubMed PubMed Citation Articles by Singh, H. Articles by Petersen, L. A.

Errors in Cancer Diagnosis: Current Understanding and Future Directions

Hardeep Singh, Saurabh Sethi, Martin Raber, Laura A. Petersen

From the Health Policy and Quality Program, Houston Center for Quality of Care and Utilization Studies, and the Center of Inquiry to Improve Outpatient Safety Through Effective Electronic Communication, Michael E. DeBakey Veterans Affairs Medical Center; Section of Health Services Research, Department of Medicine, Baylor College of Medicine; Division of Gastrointestinal Medical Oncology, M.D. Anderson Cancer Center; and University of Texas School of Public Health, Houston, TX

Address reprint requests to Hardeep Singh, MD, MPH, VA Medical Center (152), 2002 Holcombe Blvd, Houston, TX 77030; e-mail: hardeeps{at}bcm.tmc.edu

Purpose: Errors in cancer diagnosis are likely the most harmful and expensive types of diagnostic errors. We reviewed the literature to understand the prevalence, origins, and prevention of errors in cancer diagnosis, focusing on common cancers for which early diagnosis offers clear benefit (melanoma and cancers of the breast, colon, and lung).

Methods: We searched the Cochrane Library and PubMed from 1966 until April 2007 for publications that met our review criteria and manually searched references of key publications. Our search yielded 110 studies, of which nine were prospective studies and the remaining were retrospective studies.

Results: Errors in cancer diagnosis were not uncommon in autopsy studies and were associated with significant harm and expense in malpractice claims. Literature on prevalence was scant. For each type of cancer, we classified preventable errors according to their origins in patient-physician encounters in the clinic setting, diagnostic test or procedure performance, pathologic confirmation of diagnosis, follow-up of patient or test result, or patient-related delays.

Conclusion: The literature reflects advanced knowledge of contributory factors and prevention for diagnostic errors related to the performance of procedures and imaging tests and emerging understanding of pathology errors. However, prospective studies are few, as are studies of diagnostic errors arising from the clinical encounter and patient follow-up. Future research should examine further the system and cognitive problems that lead to the many contributory factors we identified, and address interdisciplinary interventions to prevent errors in cancer diagnosis.

Supported by Grant No. K23CA125585 from the National Cancer Institute to H.S. L.A.P. was a Robert Wood Johnson Foundation Generalist Physician Faculty Scholar (Grant No. 045444) at the time of this work and a recipient of the American Heart Association Established Investigator Award (Grant No. 0540043N). This article is the result of work supported with resources and the use of facilities at the Houston Center for Quality of Care & Utilization Studies, The Center of Inquiry to Improve Outpatient Safety through Effective Electronic Communication, and Michael E. DeBakey Veterans Affairs Medical Center.

The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs or the official views of the National Cancer Institute or the National Institutes of Health.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.