I’ll See You in Court!

Posted on: June 23rd, 2017 by admin 4 Comments

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We recently reviewed the false-negative conundrum and the devastating consequences for a woman if a malignant breast tumour is missed at screening. Of course, the conundrum – defined as “a confusing and difficult problem or question” – can also be devastating for the radiologist who missed the diagnosis. The Independent newspaper in the UK has recently reported the case of Dr Kong Fa Lan, a radiologist who has been allowed to continue practising despite being at the centre of a breast screening scandal.

In mid-2012, a 46-year-old woman was referred by her general practitioner (GP) to Ipswich Hospital after suffering pain and nipple discharge for six months. Dr Lan carried out a mammogram and an ultrasound examination, concluding there was no evidence of abnormality, although he did identify a small mass which he thought was a lymph node. However, in September 2014 the woman’s GP urgently referred her again to the same hospital, and this time Dr Lan performed a biopsy which confirmed she had a malignant tumour.

An expert appointed by the General Medical Council (GMC), which regulates the professional conduct of doctors in the UK, found there were significant failings in the way Dr Lan reported the original imaging results, but the GMC nevertheless concluded that no further action was required. The patient, who suffered excruciating pain between her two visits to the hospital, was understandably upset, and commented: “It makes me so angry to think I could have died because this cancer wasn’t treated for 14 months after I was first seen by Dr Lan.” She decided to sue the Ipswich Hospital Trust, claiming the delay caused serious complications and had shortened her life expectancy.

In the USA, which is particularly litigious, there are numerous well-documented cases where failure to detect breast cancer has led to a lawsuit. The Medical Liability Mutual Insurance Company (MLMIC) reported the case of a 53-year-old patient who was post-menopausal and taking hormone supplements, and the radiologist, despite seeing a suspicious nodule on her annual mammogram, failed to follow up properly with the referring doctors. The woman subsequently sued all her doctors whose insurers settled for $1.85 million, although she died shortly thereafter of metastatic breast cancer.

Recognising that screening mammograms can miss cancer, over 30 states in the USA have enacted legislation that requires radiologists to inform patients if they have dense breast tissue. What is now required are innovative imaging solutions – such as CapeRay’s dual-modality Aceso system – to solve the false-negative conundrum.

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4 Responses

  1. David Dent says:

    Cancers discovered between / after screening are “interval” cancers, and the wisdom of hindsight allows the tiny vague area to be labelled in retrospect as malignant after all. This is a very difficult problem for the radiologist – the balance between over- and under- diagnosis.

  2. Come over to the Netherlands,
    We will explain the difference between screening and clinical radiology. It needs some attention obviously, before jumping to US conclusions.
    Nancy herself (are you dense?) had an occult breast cancer. Many people thinks that this exclusively occurs in dense breasts. If you really think that innovative solutions will give 100% sensitivity and 100% specificity you need some extra training.

  3. Ed Blignaut says:

    Of course Aceso will bring more selectivity into the field – thats what it is all about. It means fewer failed diagnoses, but there will always be cases which test the system to the nth degree Aceso or not. Full steam ahead and focus on dense breast tissue!
    Regards,
    Eb

  4. Kit Vaughan says:

    Thank you David, Ard and Eb for the feedback which is much appreciated.

    David: I agree that the “interval” cancer is always a tricky one and of course hindsight is a handy thing — especially for a lawyer looking to find someone to blame!

    Ard: You are, as always, quite correct about the difference between screening and diagnosis, and the focus of the Americans on dense breast tissue. I also appreciate your comment that we will most likely never reach the Holy Grail of 100% sensitivity and 100% specificity, but we should never give up trying!

    Eb: I appreciate your ongoing support and enthusiasm for our Aceso system which is undergoing final testing prior to the award of the CE Mark. Let’s think positively!