‘I should have sent cancer victim for mammogram’

A surgeon who failed to diagnose breast cancer in a woman who later died of the disease has admitted to a Medical Council inquiry that he should have sent his patient for a mammogram.

Dr C made the concession on the second day of a fitness to practise inquiry in to his treatment of a patient identified only as Ms K.

The mother of one was diagnosed with breast cancer by Dr C in June 2008, nine months after he initially gave her the all-clear.

He faces six allegations of professional misconduct, including that he failed to consider Ms K’s medical condition, that he failed to carry out an adequate examination, that he failed to refer her to a specialist, and that he failed to arrange for an adequate follow-up. He is also accused of carrying out an ultra-sound examination on Ms K when he was not qualified to do so.

On the second day of the inquiry, Dr C described himself as a perfectionist who was always seeking new skills. He said at the time he first saw Ms K, the system for checking for breast cancer in his area was not satisfactory, with patients waiting three-18 months for the now standard triple assessment examination, which involves clinical examination, mammography, and pathological examination.

He said he took a course in the use of ultrasound because he couldn’t face his patients in the clinic and tell them they would have to wait for a mammogram.

He used ultrasound to decide which women should be sent for an immediate mammogram and triple assessment. He said all women who did not receive an immediate examination would receive triple assessment in a number of months anyway.

Dr C told the inquiry that when he received a referral letter from Ms K’s GP he assigned her immediately to a triple assessment appointment for Aug 1, 2007.

He said after she failed to turn up, he thought she should be given the benefit of the doubt and so she was booked for another appointment the next week, which she also failed to attend.

He agreed that on her third appointment, Ms K was not booked in for a triple assessment but instead booked for a general assessment with access to the triple assessment clinic.

He told the inquiry he thought that “maybe she’s not as worried as her letter reads”.

Under cross-examination, Dr C said after examining Ms K with his hands and ultrasound, he came to the conclusion that the lumps in her breast were benign and the result of dense tissue, which was quite common in a woman of this age.

Asked by Rory Mulcahy, counsel for the Medical Council chief executive, if he was correct, Dr C replied that “retrospectively, unfortunately I was not”.

Dr C said it was unfortunate Ms K did not turn up for a further appointment he offered her three months later, and that she waited nine months before she attended for the triple assessment investigation which identified her breast cancer.

The fitness to practise inquiry is expected to hear from one final witness today before retiring to consider a verdict.