Hodes Milman Launches “The California Missed Diagnosis Project” to Raise Awareness of Breast Cancer Diagnostic Failures

Hodes Milman, a California medical malpractice law firm based in Irvine, announced the launch of The Missed Diagnosis Project: California, a statewide awareness initiative focused on breast cancer misdiagnosis and delayed diagnosis. The initiative highlights how breast cancers are most often missed when radiologists misinterpret mammograms or ultrasounds — classifying a conspicuous finding as negative or benign when it warranted further diagnostic evaluation or biopsy — and when clinicians fail to promptly work up reported symptoms, such as a palpable lump that is dismissed too quickly as a cyst or not imaged in a timely manner.

The project will examine how breast cancer diagnostic failures happen, who faces the greatest risk, and what patients can do when the medical system fails to provide timely answers. Hodes Milman will use the initiative to highlight common breakdowns in care, including misread mammograms and ultrasounds, missed or misclassified imaging findings, failure to order additional imaging when symptoms or risk factors warrant it, delayed referrals, incomplete diagnostic workups, communication failures, lack of biopsy after suspicious results, and abnormal test results that never receive timely follow-up.

“Breast cancer misdiagnosis is not just a legal issue. It is a patient safety failure,” said Dan Hodes, founding and managing partner of Hodes Milman. “In the cases we most commonly see, a mammogram or ultrasound shows something that should have prompted further evaluation, but the finding is read as benign. In others, a patient reports a lump or other symptom and does not get the imaging or biopsy she needs in time. Either way, the medical system has a duty to act, and too often patients get reassured, delayed, or lost in the system until the cancer advances.”

Research and malpractice data show breast cancer remains one of the most common and consequential areas of diagnostic failure. A 10-year analysis of breast cancer malpractice cases found delayed diagnosis appeared in 82% of cases, with an average diagnostic delay of 17 months. The study also found that lack of surgeon referral, lack of recommended follow-up, and delays of 12 months or more were associated with plaintiff payments.

Broader malpractice data also points to communication breakdowns as a major patient safety problem. CRICO’s Candello database, affiliated with the Harvard medical community, reviewed more than 73,000 closed malpractice cases and 64,000 asserted cases nationwide from 2014 to 2024. CRICO has identified communication failures as a major driver of malpractice risk and patient harm.

The financial consequences can also be severe. While the report notes that no single authoritative study calculates the average personal cost of a breast cancer misdiagnosis, stage-based treatment data provides a strong proxy for the harm caused by delayed diagnosis. Breast cancer was the most expensive cancer to treat in the United States in 2020, accounting for $29.8 billion in medical and prescription drug costs. When delayed diagnosis allows breast cancer to progress from Stage I/II to Stage III or IV, treatment costs can rise by roughly 58% to 88% over the first two years.

The Missed Diagnosis Project: California will focus on both sides of this problem: how imaging findings get misread or under-called, and how the follow-up process after abnormal mammograms too often breaks down. Studies from the Breast Cancer Surveillance Consortium and UCSF-linked researchers have emphasized that mammography only protects patients when images are accurately interpreted and when abnormal results lead to timely diagnostic imaging, biopsy, referral, and communication with the patient.

“An abnormal mammogram should trigger action, not confusion,” Hodes said. “And a mammogram or ultrasound that is read as normal should actually be normal. The danger comes when a suspicious finding is under-called, or when no one clearly tells the patient what the result means, who is responsible for follow-up, or when additional testing needs to happen.”

The initiative will also examine the appropriate use of MRI screening for higher-risk patients. Women with dense breast tissue and a strong family history of breast cancer may benefit from MRI, which is more sensitive than mammography and can detect cancers — including invasive lobular carcinomas, which are notoriously difficult to see on a mammogram — that standard screening can miss. When imaging centers recommend supplemental MRI for these patients and primary care providers do not act on those recommendations, cancers can progress to advanced stages before they are finally identified.

The initiative will also address racial, geographic, and age-based disparities in breast cancer diagnosis. Studies show Black women face some of the most serious diagnostic risks, including higher rates of delayed diagnostic evaluation, delayed biopsy, lower same-day diagnostic follow-up after abnormal screening, higher false-negative diagnostic mammography rates, later-stage diagnosis, and higher breast cancer mortality. Other studies show Hispanic, Asian/Pacific Islander, and American Indian women also face gaps in follow-up and diagnostic completion after abnormal screening results.

Geography also matters. Rural women face higher risks of advanced-stage breast cancer diagnosis, particularly in regions where patients must travel farther for imaging, biopsy, surgery, or oncology care. Research has linked rural residence, limited access to specialists, fewer local surgeons, and weaker follow-up infrastructure to later-stage diagnosis.

Younger women also face distinct risks. Breast cancer in women under 50 can present outside standard screening expectations, and younger patients often report symptoms such as a lump before they receive a diagnosis. California Cancer Registry data analyzed by UC Davis found early-onset female breast cancer increased in California from 2006 to 2021, with stage IV early-onset female breast cancer increasing 2.4% per year during the study period.

The project will educate patients about warning signs and follow-up rights, including when to ask for additional imaging, diagnostic mammography, ultrasound, MRI, biopsy, referral to a breast specialist, or a second opinion — including a second read of a mammogram or ultrasound. It will also encourage patients to request copies of imaging reports, pathology reports, referral records, and follow-up instructions.

“Patients should not have to become their own safety net,” Hodes said. “But until the system improves, women need to know what questions to ask, what records to request, and when a delayed answer — or a reassuring answer that does not match their symptoms — is not good enough.”

The Missed Diagnosis Project: California will provide public education on questions patients can ask after abnormal breast imaging or unresolved symptoms, including:

• What did the imaging report actually say?
• Was the result classified as suspicious or probably benign, and does that classification match my symptoms and risk factors?
• Given my breast density and family history, should I have supplemental MRI screening?
• Do I need diagnostic imaging, ultrasound, MRI, or biopsy?
• Who is responsible for ordering the next test?
• When should follow-up occur?
• Should I see a breast surgeon or specialist?
• What should I do if my symptoms continue despite a “normal” test?

“Many breast cancer diagnostic failures do not happen in one dramatic moment,” Hodes said. “They happen through a series of missed opportunities. A suspicious imaging finding gets under-called. A recommended MRI never gets ordered. A referral does not get made. A patient gets told to wait. A lump gets dismissed. By the time someone finally acts, the disease may be far more advanced.”

Hodes Milman represents patients and families harmed by medical negligence, including cancer misdiagnosis, delayed diagnosis, hospital negligence, birth injury, surgical negligence, and other serious medical malpractice matters. Dan Hodes is a founding and managing partner of the firm and has spent nearly 40 years handling complex medical malpractice cases. Learn more about Dan Hodes.

About Hodes Milman

Hodes Milman is a California medical malpractice and personal injury law firm based in Irvine. The firm represents patients and families in cases involving medical negligence, cancer misdiagnosis, delayed diagnosis, hospital negligence, surgical errors, birth injuries, catastrophic injuries, and wrongful death.