Cancer misdiagnoses - Incompetent and, also, inexcusable

Patient A, the unidentified 51-year-old Tipperary woman at the centre of last week’s cancer misdiagnosis controversy, has issued a statement covering multiple misdiagnoses of her breast cancer over a period of 18 months from September 2005 to March 2007.

In September 2005 she discovered a lump in her breast and was referred to a consultant at Barringtons Hospital, Limerick. She underwent a mammogram, ultrasound and lumpectomy.

On the basis of the mammogram and ultrasound, she was told it was a near certainty she was suffering from cancer at the time. The lump sample was sent for a histology examination to determine the kind of cancer.

To her surprise the histology report from University College Hospital Galway (UCHG) was that the lump was benign. No further tests were done until nine months later when her symptoms worsened. She went through similar tests again at Barringtons Hospital but again there was a further misdiagnosis.

After another nine months, with the symptoms increasing, she had a needle biopsy at Barringtons Hospital, but UCHG again reported the lump was benign. This time the consultant at Barringtons sent material to Cork University Hospital for a separate biopsy, where the cancer was diagnosed within a week.

Patient A underwent an immediate mastectomy, along with intensive radiotherapy and chemotherapy. When the original tissue taken 18 months earlier was re-examined, the original misdiagnosis was discovered.

This was not just a case of her cancer being misdiagnosed once, or even twice, but three times.

In a life and death situation where speed of discovery is of the essence, this is an intolerable situation.

Compounding the mistakes, Patient A complains that Barringtons Hospital took no steps to investigate the misdiagnoses. This should have been the absolute minimum to protect others against similar mistakes. It was her consultant oncologist at the Mid-Western Regional Hospital, Limerick, who reported the case and nine other cases at Barringtons Hospital to the Health Information and Quality Authority.

As long as people are fallible, mistakes will occur, but any health service worth the name should strive to minimise such mistakes. What makes this misdiagnosis three times worse is the fact that there were two further misdiagnoses, and when the mistake was discovered, the hospital authorities do not appear to have made any effort to examine why the UCHG failed to detect the cancer in the three previous tests.

Doctors do make mistakes and this should not be a capital offence, but the reality is that such delays in diagnosis may well incur a death penalty on innocent patients. Hence what happened was not only incompetent and unprofessional but also inexcusable.