Breast radiologists are sued more frequently in the United States than Canada, according to a new analysis published Aug. 5.

Members of the specialty were named in 3,108 malpractice cases across America’s neighbor to the north, with 6% relating to breast imaging or biopsy between 2002 to 2021. Medical mistakes most frequently stemmed from factors related to the radiologist (64%), followed by team- (23%) and system-based (7%) causes, researchers wrote in the Canadian Association of Radiologists Journal [1].

In comparison, breast cancer is the most common cause of missed diagnoses in the specialty across the U.S., according to one previous study in Radiology.

“This is a positive finding for radiologists practicing breast imaging in Canada, showing that the Canadian medico-legal landscape differs markedly from the USA, and radiologists practicing breast imaging in Canada are subject to a lower risk of medico-legal cases,” Dr. Jean Seely, with the Department of Radiology at Ottawa Hospital, and co-authors noted. “It is not clear what are the reasons for the lower number of lawsuits in Canada for breast imaging compared to the USA,” they added later.

Researchers obtained their information in collaboration with the Canadian Medical Protective Association, which offer physicians assistance in dealing with malpractice matters. The analysis found that male and female radiologists were equally impacted by medical malpractice cases in Canada. From 2006 to 2015, the authors also unearthed an increasing number of cases involving radiologists, while those related to breast imaging dropped during that timeframe.

Of the 188 breast imaging malpractice cases recorded in Canada, diagnostic error was the most common cause at 82%, while 67% involved the misinterpretation of a diagnostic test. Seely et al. speculated on several reasons why the U.S. sees more breast imaging-related malpractice cases than Canada. Male radiologists have a higher rate of being sued than their female colleagues, one 2013 study found. And a larger proportion of breast radiology “is thought to be done by women radiologists” in Canada, though data are lacking. Universal healthcare coverage also may impact the numbers, making payouts occur less frequently than in the U.S., where coverage is more variable.

“One other potential reason for the decreasing low rate of medico-legal breast imaging cases is that many breast radiologists communicate directly with patients with more ‘face-to-face’ interactions than in other aspects of radiology,” the authors noted, pointing to a 2011 study on the topic. “The open communication with the responsible radiologist was found probably to have prevented subsequent litigation,” the authors added later. “As an additional benefit, it has been shown that direct communication between radiologists and patients improves the quality of imaging reports. We believe direct communication with patients by breast radiologists may have contributed heavily to this improvement.”