Mandatory triple tests for breast cancer patients

WOMEN with suspected breast cancer must have three experts check their test results before a diagnosis is made under new standards to be enforced.

Under the “triple assessment” policy, the radiologist who takes the mammogram, the surgeon who removes the lump and the pathologist who examines it under lab conditions must all agree on whether it is benign or cancerous.

The procedure is designed to minimise the risk of misdiagnosis of patients such as happened to at least two women who attended Barringtons Hospital in Limerick, where breast cancer services have been suspended pending a review of about 1,000 patient files.

Some facilities already apply the standard that is considered international best practice but despite being urged in several Department of Health reports, it has never been mandatory.

The doctor who raised the concerns about Barringtons, Professor Rajnish Gupta, said last week if triple assessment had been the policy at the private Limerick hospital as it was in the public Mid-West Regional Hospital in the city where he was based, the misdiagnoses highlighted — one of which was not caught for 18 months — would have been seen earlier.

“In a multi-disciplinary meeting, and if this lady had come to us, we would have discussed all this. The surgeon, would have said, ‘I felt a lump, I think it’s malignant.’ The radiologist would have looked at it and said, ‘I think it’s malignant.’ The pathologist would have said, ‘I thought it was benign, I’ll go back and look at it.’ So within days the biopsy would have been reviewed and the mistake corrected.”

Barringtons was using pathologists working in labs based at University College Hospital Galway when the misdiagnoses were made so the medics did not meet for a triple assessment.

Mammography and breast ultrasound services have also been suspended at the Midland Regional Hospital in Portlaoise, where about 5,000 tests are to be reviewed following concerns about accuracy.

Last May, Health Minister Mary Harney published quality assurance standards for breast cancer services, which included triple assessment, but she set no date for their commencement.

The Health Information and Quality Authority (HIQA) said however it would begin checking all breast cancer services in the coming months to ensure they complied.

HIQA chief executive Dr Tracey Cooper said the decision was made in light of present concerns.

“We know that patients are more likely to survive if they are treated in specialist centres that have an organised triple assessment approach to the care provided. It is vital that the Health Service Executive and all other providers providing symptomatic breast services, implement these standards as a priority.”

The Irish Cancer Society welcomed the announcement which it said was overdue.