Poor breast imaging service led to 'avoidable' diagnostic delays

O'DOHERTY REPORT:WOMEN ATTENDING Midland Regional Hospital in Portlaoise suffered a significant and avoidable delay in the diagnosis of their breast cancer because of low standards in the breast imaging service, a report has found.

There was clear evidence that the safety, quality and standard of many aspects of the service fell well below achievable best practice for breast imaging, according to the report by Dr Ann O'Doherty, a radiologist and clinical director of BreastCheck.

Nine women who had been given the all-clear by the service were found to have cancer when their mammograms were reviewed by Dr O'Doherty and two other radiologists.

The time that elapsed between the original "false negative" mammogram and the new diagnosis varied between 4½ months and two years, nine months, according to the report.

Seven of the mammograms with undetected malignancies were originally handled by two radiologists, who are not named, who have permanent consultant appointments at the hospital.

However, the figure of nine misdiagnoses out of the 3,037 mammograms reviewed falls within the rates for "false negatives" published within similar reviews, according to Dr O'Doherty.

Dr O'Doherty's report says that the quality of the mammograms presented for review was patchy, mostly for technical reasons.

Problems with quality related to the processing of the images rather than to the machine used, she suggests, although the report also points out that the imaging machine used at the hospital was probably five years older than the normal 10-year lifespan.

Many of the reports issued on mammography and breast ultrasound at the hospital were difficult to interpret, and their quality resulted in significant difficulty for clinicians delivering the service.

"They lacked clarity, specificity, and helpful conclusions that could have directed clinical management. Abnormalities were not reported in concise terms and reports did not suggest image-guided biopsy," the report states.

In some cases, surgical biopsies were suggested, even though the mammogram was normal.

Dr O'Doherty is critical of the fact that the "cornerstone" of breast care services, triple assessment involving clinical assessment, X-rays, ultrasound and, if deemed necessary, biopsy, was not used at the hospital.

She recommends that no further breast imaging be carried out at the hospital unless national standards for such a service are met.

In the light of the recent Government decision to concentrate breast cancer screening in eight centres nationally, an immediate decision on the future location of such services in HSE Dublin Mid-Leinster is needed, she says.

Patients diagnosed with breast cancer as a result of her review should be fully informed about the circumstances of their initial misdiagnosis, the report recommends.

Women aged between 50 and 64 and who do not show symptoms of breast cancer should be encouraged to take up their invitation to attend for breast screening as part of the National Breast Screening Cancer Programme, rather than having regular mammography in their local hospital.

A separate, brief report on the clinical review of breast ultrasound services at the hospital says that all 607 reviews were found to be negative.

The report, by John Bulfin, HSE network manager, Dublin Mid-Leinster, says letters were issued to 435 patients informing them that the review of their ultrasound reports and chart notes was negative.

Some 143 patients were invited to see a consultant in clinics in Dublin and Portlaoise, but all diagnostic tests on these patients were negative.