MONTREAL – A sweeping medical study of thousands of mammograms in Quebec has found 109 cases of breast cancer that had not been previously diagnosed.
The provincial College of Physicians and Surgeons, which carried out the investigation, said Monday that all the patients whose cancer was missed have since been treated and no one died.
The professional body proposed a series of recommendations to avoid such a situation in the future, including monitoring by a panel of four expert radiologists to assure quality control, and double-checking of results. Several of the recommendations have already been implemented or are in the process of being implemented.
The radiologist at the centre of the misdiagnosis retired in October 2010, a month before the college was informed there might have been errors in his readings of mammogram results.
The radiologist had worked at three different private clinics and the inquiry re-examined all the radiologist’s cases between October 2008 and October 2010.
Charles Bernard, a spokesman for the college, said 96 cancer cases were discovered as a result of the re-evaluation and noted the College’s two investigators found “an unusually high number of discrepancies on the films reviewed.”
The other 13 cancers were found after the investigation was expanded to include other radiologists working in the same clinics.
The inquiry concluded that these cancers would not have been obvious to the radiologists.
Yves Robert, the secretary of the College of Physicians, said it is very difficult to spot a lesion on a mammogram.
“Yes, it’s possible to miss because it depends on an expert eye,” he said. “There is always the possibility of error.
“It takes a lot of skill, expertise, to not miss this tiny lesion which is at its beginning.”
Frederic Desjardins, president of the radiologists’ association, agreed that it is difficult to detect problematic lesions because mammograms are less evolved than other types of examinations such as scans, ultrasounds and magnetic resonance imaging which allows for better visualization.
“Mammography has not gotten to that point,” he said.
However, he insisted that mammograms remain the best way to detect breast cancer.
Desjardins said the radiologist in question is an unfortunate and “unhappy case.” He said the errors were mainly due to the fact that he worked alone, without benefit of feedback from colleagues.
Since the investigation started, two of the clinics have changed hands and one has closed. Robert said since the radiologist has retired there is little the college can do.
However, the women involved can sue.
“Certainly, there are lawsuits underway currently,” Robert said. “The best advice we can give women is to consult a lawyer and see what recourse is possible, if they deem it appropriate, for compensation.”
Health Minister Yves Bolduc said in Quebec City that it is important to him that the women diagnosed with cancer were treated rapidly. He said it is vital that the recommendations of the college be implemented as soon as possible to correct deficiencies in the system.
The Canadian Cancer Society said in a statement that it was saddened that 109 women currently fighting breast cancer did not receive appropriate follow-up treatment after their routine mammogram.
“The findings (of the college) show flaws in our health system and the fact that we must remain very vigilant,” the agency said.
It’s not the first controversy involving breast-cancer tests in Canada.
In Newfoundland, there was a judicial inquiry after mistaken results in 386 cases. The inquiry made dozens of recommendations.
Unlike the Quebec case, however, the problems in Newfoundland occurred with patients who had already been diagnosed with breast cancer but may not have received the correct treatment following errors in hormone receptor tests.
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