01 February 2016
Breast Cancer – The Causes of Clinical Negligence
Mistakes in the diagnosis and treatment of breast cancer give rise to a significant number of claims for damages by patients who have suffered loss as a result of medical mistakes.
Whilst working on a case for a family of a woman who sadly died of breast cancer recently, I carried out some research on reported cases to see what the most common causes of errors are.
The results were not particularly surprising because they accord with our own experience of handling claims for the victims of medical errors, particularly in regard to claims involving breast cancer.
The most common error is a failure by GPs to refer patients for investigation. There are very clear guidelines produced by the National Institute for Health and Care Excellence (NICE) that require healthcare professionals to examine suspicious lumps:
- Where the lump is discrete, hard and fixed in place (with or without skin-tag tethering), patients should be referred urgently.
- Women aged over 30 with a discrete lump that persists after their next period or presents after menopause should be referred urgently.
- Women under 30 (for whom breast cancer is rare but benign lumps are common) should be referred urgently if a lump enlarges or has other features associated with cancer (e.g. it is fixed and hard) or if there are other reasons for concern such as family history.
- An urgent referral should also be made in patients with eczema on only one breast or patients with changes to their nipples that do not respond to topical treatment or nipple discharge.
Another common error appears to be breast surgeons carrying out an examination but failing to perform what is known as the triple assessment, which involves three forms of investigation:
- clinical assessment (i.e. feeling the lump);
- radiological investigation by mammogram or ultrasound scan;
With a biopsy, a small amount of tissue is removed using a needle before cells are examined under a microscope by a pathologist. In a number of previous cases, a breast surgeon has carried out an examination, concluded that a patient’s lump was not suspicious and failed to investigate further.
In a case on which I am currently working, a breast surgeon rightly concluded that a lump was not itself suspicious. However, she failed to take into account that abnormalities of this type are often associated with cancer and had she investigated further, she would have diagnosed the condition at a stage when treatment would have been effective. Instead, there was a two-year delay in making the diagnosis by which time the treatment was too late to save the woman’s life.
A further common area involves mistakes in interpreting mammograms, ultrasound scans and pathology samples. In another case I conducted, the mammogram was correctly interpreted but because of a clerical error, the surgeon was told the results were not suspicious when they, in fact, clearly suggested the woman had cancer.
There have been a series of cases involving one particular surgeon, Ian Paterson in Birmingham, who removed inadequate amounts of breast tissue leaving patients at risk of their cancer recurring. My colleagues are currently acting on a large number of these claims.
There are also a relatively small number of claims where women are wrongly diagnosed as having cancer when they are free of the disease. As a result, they have to undergo the trauma of facing a cancer diagnosis as well as very intrusive treatment which can include mastectomies and chemotherapy.
The fact that errors in the management of breast cancer fall into clear categories means that it should be possible to learn from mistakes and avoid the same things from happening again.
Breast cancer is one of the most common forms of cancer in Britain with more than 50,000 women diagnosed with the condition each year. Although more women survive their cancer thanks to better awareness and improvements in screening and treatment, we are still seeing avoidable errors.
Breast cancer is a devastating condition and it should be possible to eliminate many of the mistakes which lead to people suffering medical negligence.
Paul Sankey is a senior clinical negligence solicitor at Slater and Gordon Lawyers in London.
The medical negligence solicitors at Slater and Gordon have won significant awards for patients who have wrongly been diagnosed with breast cancer and who have had breast tissue removed unnecessarily.
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