Breast surgery may have been unnecessary

SOME patients attending Barringtons Hospital in Limerick may have had unnecessary breast surgery because of shortcomings in its breast care services, a review has found.

The independent review of breast care services at Barringtons reviewed patient care between September 2003 and August 2007. It found the service suffered due to the lack of a multidisciplinary cancer care team, the absence of on-site pathology expertise and the non-availability of essential diagnostic technology such as image-guided biopsy.

“In a number of patients, the lack of effective triple assessment prior to surgery may have lead to unnecessary surgical intervention with its associated risks,” the review team found.

“In other patients with cancer, two surgical procedures were undertaken, where, with triple assessment prior to surgery [clinical examination of the breast(s), imaging mammography and/or ultrasound and pathology sampling], one definitive intervention could have been undertaken.”

In other words, the service did not meet the National Quality Assurance Standards for Symptomatic Breast Disease Services, the benchmark against which our proposed new centres of excellence will operate.

As Denis Cahalane, Barringtons general manager, is anxious to point out — and he is backed up by the findings of the review team — the service they offered was not a whole lot different from that in many hospitals around the country where multidisciplinary team meetings and triple assessment were not the norm.

Mr Cahalane is also keen to highlight that the level of misdiagnosis at Barringtons was within the range of error you would expect to find in the best of cancer care centres.

The review at the hospital began in the wake of the misdiagnosis of two patients and complaints by the regional director of cancer services in the mid-west, Prof Rajnish Gupta, to the Health Information and Quality Authority and the Department of Health about the care of 10 women who attended the breast disease services at Barringtons.

Mr Cahalane is at pains to point out that one of the missed diagnosis was the fault of the pathology laboratory in University College Hospital Galway. “The senior pathologist in Galway wrote to us acknowledging that they re-read the original report and acknowledging that the original biopsy of September 2005 showed malignancy. He apologised sincerely for the error that occurred in their lab,” he said. He conceded that the second missed diagnosis was Barringtons’s fault, a mammography was misread.

Mr Cahalane claims the report vindicated their treatment of the patients Prof Gupta had expressed concerns about.

285 patients took part in the review. Of these, 139 received “entirely satisfactory” treatment, 118 did not, 26 required further assessment and as yet, with the results of two women as yet unknown, there have been no further cases of misdiagnosis. The review team concluded that for the majority of women there would be “no lasting harm”.

The team, headed by Dr Henrietta Campbell, former chief medical officer in the north, concluded that while it did not find any new misdiagnosis, “it did find a level of inappropriate care in more than half the women who consented to their records being reviewed”.

Mr Cahalane said he “firmly believed the report hadn’t achieved anything for women with breast cancer” and would make breast cancer a more difficult arena for doctors to work in.