Breast cancer misdiagnosis
With between 2,000 and 2,500 women diagnosed with breast cancer each year in Ireland, it remains the most common cancer affecting women. The incidence of the cancer is thankfully decreasing and particularly over the last five years or so, what had been a trend of increase seems to have been halted and put in reverse.
Mortality rates associated with the cancer, more importantly, are also being reduced by a combination of factors chiefly to do with improvements in treatment and greatly improved practices for the early detection of the cancer.
Detection comes about by either screening or symptomatic breast examination. The difference is that screening is the examination of apparently healthy women and symptomatic examination occurs where there is some suspicion of a lump or tumour.
In Ireland now, there is the national breast screening programme whereby women over 50 years are offered and encouraged to have a mammogram every two years and one of four regional centres and mobile units while those attending their doctors with a queried breast lump are in most cases now being referred to one of the 8 centres of excellence for a multi-disciplinary assessment involving breast exam, radiology and if necessary, biopsy. This triple assessment is believed to give the best chance of a correct diagnosis.
Until recently I had believed that the private hospital sector had stopped offering stand-alone breast care services, particularly in the wake of appalling errors that caused terrible harm to patients. It seems however from some very recent cases that I have been working on that the private hospital sector, being essentially unregulated by State authorities such as HIQA or the Department of Health, is still offering such services in the absence of multi-disciplinary safeguards. Such practices have been shown in the past to be a recipe for disaster. Economic considerations or loyalties among health care providers should not be allowed to get in the way of ensuring that women only receive breast cancer investigations at one of the 8 approved centres of excellence. In South Tipperary, that means going to Waterford Regional Hospital or Cork University Hospital while North Tipperary is covered by the Mid Western Regional Hospital centre.
If you are worried about a breast lump and you are being referred to anywhere other than one of the eight centres for a mammogram or other breast examination, you should probably call the Irish Cancer Society on Freephone 1800 200 700 to talk to a specialist cancer nurse.
It is the issue of early detection, rather than treatment that generally involves a law firm working in the area of medical negligence as overall, misdiagnosis is the most common type of medical negligence case – roughly one-quarter of all cases – and the failure to diagnose cancer is the most common form of misdiagnosis that results in a malpractice/negligence claim. (For those interested in the statistics, the most commonly missed cancers are breast cancer, colorectal cancer, and prostate cancer.)
There are no available statistics on breast cancer misdiagnosis in Ireland – at least none that are published. Whether the problem is widespread or not makes little difference to the women and the families who are affected by it but of the women I act for, there has been one striking common factor, and this applies to clients who have had cervical cancer misdiagnosis also – they all presented to their doctors believing that there was a health issue and they all expected that following testing they would be given bad news – a diagnosis of cancer – but instead they were reassured and sent away. In each case there was no follow up though most self-referred themselves back for further investigation. Then after a delay in diagnosis of usually at least one year, treatment was commenced on what was by then a larger and more threatening cancer tumour.
Breast cancer can be difficult and complicated to treat, with many cancer specialists recommending a combination of surgery, radiation therapy, chemotherapy, or hormone therapy based on the specifics of the cancer, making early detection extremely important. Where an error occurs that leads to a delayed diagnosis and delayed treatment, that failure usually results from one or more of three main types of negligence.
First, because breast cancer risk is so strongly correlated with a patient’s family history, genetics and risk factors, it is essential that ever woman’s primary care physician and gynecologist obtain a complete medical history, including by identifying any relatives – whether part of the patient’s immediate family or further out – who have been diagnosed with any form of breast cancer or ovarian cancer. A detailed family history is essential in determining how a patient should be followed and counseled on their options. Women whose family history includes more than one relative diagnosed with breast cancer should be counseled to have a blood test performed to see if they have the BRCA-1 or BRCA-2 gene, which can reduce the body’s ability to fight tumors, and thereby make a woman much more likely to develop breast cancer and for that breast cancer to metastasize to other organs, like the lungs or the spine. Women with one of the BRCA genes also should have prophylactic mastectomies recommended to them so that they know the full availability of treatment options.
Second, although public health campaigns stress to women the need to examine themselves for lumps in their breasts or changes to the appearance of the breast or nipple, doctors sometimes fail to follow-up on this reporting by patients. Even if a primary care physician is unable to find a lump described by the patient during a breast examination, the doctor should nonetheless continue to follow-up on the possibility of breast cancer until they can assure themselves that the patient does not have any abnormalities. For example, even if a doctor cannot find a lump reported by the patient in the doctor’s examination, the doctor should refer the patient to one of the 8 centres of excellence for a multi-disciplinary assessment.
Third, because the screening, diagnosis, and treatment for breast cancer can involve so many different physicians, there is increased scope for error. In theory, a triple assessment by physician, radiologist and pathologist, in discussion with one another, should provide a safe and correct diagnosis but even in this system, devastating errors can occur, particularly where an incorrectly read mammogram or ultrasound fails to identify a tumour and so no biopsy is taken and the patient is denied what might be a timely diagnosis. Similarly, if a patient has progressed from a mammogram to a biopsy or a mastectomy, then it is essential that the radiologist, surgeon, and primary care physician all remain in close contact about the exact nature of the biopsy and mastectomy performed to ensure that every area of concern has been addressed and to ensure that, in the future, areas which have not been addressed will be monitored carefully.
Fourth, many breast cancer misdiagnosis cases revolve around something as simple and tragic as the failure to read a test correctly. Sometimes a primary care physician appropriately performs an ultrasound after a patient reports finding a lump, but the physician fails to recognize that lump on the ultrasound. Other times, a full mammogram is performed, but the radiologist improperly characterizes a cancerous tumor as an infection or other inflammation. In some cases, a biopsy is performed, but the results are never appropriately reported to the surgeon or any others involved in the patient’s care, leading many of the physicians to incorrectly conclude the biopsy is negative.
If you have a query regarding this article, call Cian O’Carroll Solicitors, A Medical Negligence & Personal Injury Law Firm on FREEPHONE 1-800 60-70-80 or visit our website at WWW.TIPPLAW.COM
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