Delayed diagnosis of breast cancer

Mrs T attended a breast clinic with symptoms of nipple inversion, tethering and pain. Prior to imaging, this was diagnosed as being scar tissue from pre-existing implants. Imaging was carried out via mammogram and ultrasound, which found no suspicious lesion or mass. She was discharged with advice on breast pain.

The following year, Mrs T revisited the clinic, at which time she was diagnosed with a tumour.

The breach was initially based on the incorrect reporting of the mammogram, which the expert indicated showed clear asymmetry and mandated radiology request for further investigation by MRI. The breast surgeon largely deferred to that assessment, but did indicate that a P3 clinical assessment (breast triple assessment for detection of breast cancer) was also appropriate given the tethering; and agreed that MRI was the correct investigation given the absence of a mass to biopsy. MRI would have been diagnostic. The primary causative effect was delayed, rather than immediate, reconstruction, without LD flap (a method of breast reconstruction) or chest wall radiotherapy.

A prolonged absence from work was required, but there was significant doubt whether the absence was due to the surgery or the chemotherapy which was not avoidable. This was compounded by the Client being subsequently diagnosed with a number of complaints which were clearly the result of the breast cancer treatment rather than the effects of the delay.

The Claim was denied in its entirety, based on the Defendant’s claim to have adhered rigidly to the Best Practice Guidelines, and their contention that MRI is not a diagnostic tool. In essence, they averred that. Although they accepted that she did indeed have a multi-focal tumour at the time, it was entirely acceptable in the absence of a mass or imaging concern to discharge her. They disputed that there was in fact anything shown on imaging.

In joint meetings, the radiologist agreed there was no breach in interpreting the mammogram and no breach in not requesting the MRI. Both radiologists did allow that in the event of discordance between imaging and clinical findings, an MRI was useful. Breast surgeons agreed that tethering, plus inversion in combination, was a red flag, but differed on the action required. Mrs T’s expert felt that MRI was “indicated.” The Defendant believed that the majority of breast surgeons would discharge with no further action.

The basis of the case required some gentle adjustment. Red flag symptoms were present, and in fact clear imaging could only actually rule out benign conditions. Mrs T could therefore still have cancer, so to discharge was logically indefensible; the clinic had not fulfilled its basic function of excluding cancer. After an unsuccessful mediation, the case proceeded to trial.

Whilst at trial, Price Slater Gawne were successful in obtaining a positive outcome for Mrs T who received financial damages for the pain, suffering and loss of amenity faced.