Breast cancer misdiagnosis – two experiences

 

Price Slater Gawne has acted on behalf of far too many clients who have suffered negligent misdiagnosis of breast cancer. Whilst the ways in which that can happen are many, there are a few that keep repeating, and a slightly more detailed look at a couple of these might just prove useful to those with doubt or questions.

It is worth saying that in breast cancer cases the specific details are critical, so this is not in any way a substitute for seeing a doctor. Rather, think of this as a double-check on what you may have already been told.

Biopsy

There is a clear set of circumstances about when a biopsy is needed, which can be simply summarised as a situation when something seems to be there and you need to be sure. Typically there is some sort of physical sign: a lump, skin changes, nipple inversion, something that the patient has noticed themselves. There can be a host of innocent explanations, but the common theme when “something” is happening is that you need to know what it is.

The bulk of investigation comes down to scanning, which is the fast, easy way that does no damage. The biopsy arises when scanning alone is not enough, and the doctors need a physical sample to check.

There are clear guidelines about when a biopsy must be done, sometimes regardless of what scans show. It might surprise you to learn, for example, that if you present with what is classified as a “solid lesion”, you should expect to have a biopsy even if the scan points to something innocent. It is most likely that the lump is not sinister, and a common explanation in the cases we see tends to be that the lump is a fibroadenoma, which is not malignant. The patient may well be told that this is what the ultrasound shows. Chances are that is actually correct, but the biopsy is usually still mandatory. That’s because some cancers can look a lot like the fibroadenoma, and it is not worth missing one for the sake of a simple procedure that can find out for sure. Those are simply the rules, nationally. Find them here.

Yet there are departments who short cut that process and skip the biopsy, then claim not to know what the rules are, which is a ridiculous explanation that does not deserve the time of day. If you think I am being unduly harsh, the report on one of my local Trusts by Public Health England recorded “many standard operating procedures (SOPs) are not in line with national guidance.” One of those procedures is exactly what I refer to above, it was simply not being done, at all. There were deaths. The last case I had with this simple, ridiculous oversight cost the NHS over a million pounds.

That is an example of a very simple error. What of a more complex situation, however?

 

When triple assessment is not enough

I represented a lady whose case went as far as trial over what was actually a very basic concept.

She had been referred to the hospital breast clinic by her GP over changes in her right breast, including nipple inversion, changes in the size and appearance of her breast and pain through her breast and into her arm.

She had undergone a mammogram and ultrasound, and was advised that the changes and pain she was experiencing were due to scar tissue from pre-existing implants. At this stage, she was discharged from the clinic with advice on pain relief and guidance on personal care. She was advised that there was therefore nothing to worry about.

Breast cancer

Less than a year later she was once again referred to the breast clinic by her GP due to sustained, ongoing pain and further concern regarding the appearance of the same breast. This time, following investigations, she was diagnosed with a 70mm tumour.

The arguments in that case were lengthy, but the point that we were making, and which the Court accepted, was simply that the job had not been completed. Having done the mammogram and ultrasound, there was still no clear answer about what the problem was. There was obviously something going on, but there was no biopsy done because the implants made the job too difficult for those treating her, so they simply stopped. At trial the Court heard that there was not, in fact, any explanation for these symptoms that was not serious. Whatever it was should have been pursued.

The explanation presented by the Defendant was that, in essence, they had run out of things to try. The triple assessment of mammogram and ultrasound had taken them to biopsy, they couldn’t do that, so they had reached the end of their checklist. “Computer says no” is apparently still a reasonable outcome in some places.

MRI

When pushed, it was apparent that just down the hall was an MRI machine, it was available, and it would have found the problem. You would not usually turn to an MRI, but you can. It was not used, despite the Defendant accepting that they would have used it if they had thought there was a problem. The Defendant had not considered there to be a problem because they had taken the usual steps, even though it had not found the answer.

It is a very circular argument: no problem found because we have not looked deeper, because there isn’t a problem. This, in essence, is an argument that it is acceptable to give up even if you haven’t found an answer with the easy steps. If the consequence of doing this is that you might kill the patient then clearly it makes no sense, and the Court did not buy it, the Defendant lost.

Keep asking questions

The common theme is, sadly, really the tenacity of the team that you encounter. Most are excellent. Those that are not probably actually make very simple, avoidable errors, but they are costing lives. That cannot be permitted to continue. You can help yourself with some very basic reading, and by insisting that you get the investigation you need. You don’t need to have memorised the rulebook, but you do need to be satisfied that you have been given an answer, and that you understand how it was reached. If you are not sure, don’t stop asking questions.

If you are affected by any of the issues raised here please do get in touch today. We are here to help you.