Posted: October 10, 2013

Dr. Stark recently spoke to a legal nurse consultants continuing education course on the issue of causation in cancer-related malpractice litigation.  You can get a copy of his talk by emailing him, using the form at the right of this page.  In addition to reviewing well-known data on the common cancers —  breast, colon, lung and prostate — he delved into the new frontier of failing to screen people at high risk of getting cancer by virtue of their genetic pedigree.  The genetic mutation best known to the general public is the BRCA cluster in breast and ovarian cancer, i.e., BRCA 1 and 2.  Dr. Stark has participated in the defense of a doctor accused of failing to order these tests in a woman at increased risk.  In addition he delved into the intricacies  of the various colorectal cancer kindreds including familial adenomatous polyposis and Lynch Syndrome.  Some years ago he served as an expert on behalf of the survivors of a man with Gardner’s Syndrome whose surgeon failed to remove his rectum when performing a total colectomy.   See here for a more complete discussion of the details of this particular case.  His talk concluded with a discussion of Multiple Endocrine Neoplasia and the risk of the highly lethal Medullary Carcinoma of the Thyroid in people harboring the MEN-2 genetic mutation.    Any member of a kindred withe MEN-2, that is, a relative who tests positive for the RET proto-oncogene, should have a total thyroidectomy by age 13; if a physician does not pursue this with his patient Dr. Stark would argue that he is negligent.  Physicians of an adult with MEN-2 who tests positive for this gene must counsel the patient to have his relatives, especially his children, tested, for the children have a fifty percent likelihood of harboring the gene.   Dr. Stark believes that the reasonably prudent primary-care physician — whether internist,  family practitioner or gynecologist — needs to have a working knowledge of the family cancer syndromes and be willing to offer such patients enhanced screening either in his office or through the auspices of a genetic counselor.