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BREAST CANCER DIAGNOSIS CASE STUDY
Claim No.4MA10605
IN THE MANCHESTER COUNTY COURT
B E T W E E N:
BARRIE McCLUNEY
(Widower & Executor of the Estate of Jane McCluney, deceased) Claimant
-and-
EAST CHESHIRE NHS TRUST
Defendant
CASE REPORT
DELAY IN BREAST CANCER DIAGNOSIS
Background to the Claim
In November 1998, Jane McCluney noticed a lump in her left breast. She was seen by her General Practitioner who referred her to Macclesfield District General Hospital ("the Hospital").
Mrs McCluney was seen on the 16th November 1998 when she underwent testing by way of mammogram, ultra sound scan and fine needle aspiration cytology (FNAC). There was a positive breast cancer diagnosis and plans were arranged for either wide local excision or mastectomy in either case with axillary clearance. Following the review of the histology a diagnosis of ductal carcinoma in situ (DCIS) was substituted in place of the cancer diagnosis. On the 1st December 1998, Mrs McCluney underwent a left sided mastectomy and a specimen of tissue was removed for biopsy. On the 4th December 1998, the specimen of breast tissue was reported stating:- "there is an extensive area of high grade ductal carcinoma in situ with an area of micro invasion measuring less than 1 mm."
At a multi disciplinary review on the 10th December 1998 it was decided that Mrs McCluney needed 6 monthly reviews with annual mammograms to the age of 50 and with mammograms on an 18 monthly basis thereafter. She did not undergo axillary clearance. In November 1999, Mrs McCluney discovered a lump under her left arm. She returned to the hospital where she underwent an ultra sound scan. The scan appeared to indicate "a solitary normal looking lymph node." Mrs McCluney underwent a further review in clinic on the 13th December 1999. In the 13th March 2000 she attended at the hospital for a repeat ultra sound scan of the axilla. The Doctor undertaking the scan informed Mrs McCluney that the lump appeared small and that her Consultant would write to her with the results.
In fact the report of the scan states:-
"a palpable node in the axilla was demonstrated. It has an irregular lobulated contour with a fatty nidus within. There does not appear to have been an overall increase in the size of the node but the lobulated contour, present now, was not an obvious feature on review of the previous study obtained on the 15th November 1999. In view of those features and there apparent recent interval development, I would advise that the node is biopsed or excised. I do not think that neoplasia can be excluded." A handwritten note on the report stated:- "Bring back to the clinic urgently please."
The hospital did not arrange for Mrs McCluney to re-attend the hospital and in June 2000 she developed a swelling in a vein of the upper left arm which was painful. The General Practitioner referred her back to the hospital where she was seen on the 12th June 2000. She was told that the scan performed on the 31st March 2000 had showed some worrying changes of the lump. On the 19th June 2000, Mrs McCluney underwent left axillary clearance. 25 of the 28 lymph nodes were found to contain metastases.
In August 2000, Mrs McCluney started chemotherapy at the Christie Hospital. In February 2001 she started radiotherapy. In November 2001, Mrs McCluney developed further swelling in the axilla. A metatastic mass was removed by dissection. She then underwent further chemotherapy. In January 2004, Mrs McCluney was found to have developed recurrence of the cancer in the chest wall and she had developed lymphoedema of the left arm. In the period after January 2004 her condition deteriorated seriously and she died on the 24th July 2004.
Allegations of negligence
The Claimant alleged that the Defendant was negligent in failing to correctly report a positive breast cancer diagnosis as a result of testing the sample of breast tissue from the left mastectomy performed in December 1998 and in the management of the axillary lump reported in November 1999. He further alleged that had the breast tissue been removed in December 1998 been properly reported the Defendant would have identified that there was evidence of vascular invasion indicating that this was an invasive cancer. Mrs McCluney would have then undergone axillary clearance with a course of chemotherapy. It was argued that Mrs McCluney would have had a significant period of remission although it was acknowledged that she probably would have suffered relapse in any event. It was alleged that Mrs McCluney died prematurely because of the Defendants negligence.
The Defence
The Defendant admitted a breach of duty in that the report of the mastectomy histology carried out in December 1998 was not reported correctly. It was further admitted that Mrs McCluney would have been advised to undergo axillary clearance and she would have received adjuvant chemotherapy with CMF. This would have entailed 4–6 months of day care treatment during which Mrs McCluney would not have been able to work. The Defendant further contended that because of the aggressive nature of the cancer relapse which occurred in November 1999 would have occurred in any event all be it at a later date. The Defendant argued that the relapse would have occurred 9 months later. The Defendant argued that Mrs McCluney's life would have prolonged by no more than a further 15-18 months.
Settlement
The matter was settled shortly after close of pleadings with the Defendant paying the Claimant the sum of £22,000.00 plus his reasonable legal costs. The sum was made up of a bereavement award of £10,000.00, funeral expenses, damages for pre death, pain and suffering and an element for pre death loss of care and services provision. The settlement broadly reflected the Defendant's contentions on the issue of causation.
Expert's for the Claimant
Dr. L Bobrow, Consultant Pathologist
Dr. T Wheeler, Consultant Oncologist
Experts for the Defendant
Dr. J T Roberts, Consultant Oncologist.
Case reported by Eddie Jones, Solicitor for the Claimant
JMW Solicitors, 5/7 Byrom Street, Manchester, M3 4PF
Counsel for the Claimant – Richard Pearce, Peel Court Chambers, Manchester Solicitors for the Defendant, Hill Dickinson, Liverpool
Counsel for the Defendant, James McKeon
