A woman in her 40s was diagnosed with breast cancer five months after her surgeon failed to order a mammogram or ultrasound of a lump she had found.
The woman, referred to as Ms A in a recent Health and Disability Commissioner (HDC) decision, had earlier been diagnosed and treated for breast cancer in her left breast in 2013.
A routine check in September 2018 found a lump on her right breast and although a breast and general surgeon, dubbed Dr B, performed a fine needle aspiration biopsy (FNA) on it, they did not order a mammogram or ultrasound.
This was contrary to the unnamed District Health Board's protocal that a patient over 35 years old clinically assessed as having a "breast lump" should have a mammogram, ultrasound, and palpation-guided biopsy, followed by a image-guided biopsy if there were still concerns.
Commissioner Morag McDowell noted Dr B determined the lump to be fibrocystic.
"Had the thickening been more nodular or had it had other concerning features, then I would have proceeded with a focused ultrasound," Dr B told the HDC.
However, Ms A told the HDC the lump grew rapidly over the following five months.
Her GP referred her back to the hospital in February 2019, where a consultant radiologist found the lump to contain malignant cells.
Ms A received a mastectomy and chemotherapy, with McDowell's decision noting Ms A's treatment is ongoing.
"I feel that considering my previous history any lump found should have warranted an ultrasound and biopsy," she told the HDC.
"After experiencing both a fine needle aspiration and an ultrasound guided biopsy, I feel strongly that a FNA is blindly poking around — a biopsy can see exactly where to take tissue from."
McDowell recommended Dr B audit their last 20 assessments of patients where there was suspicion for a breast lump and report back to the HDC.
Dr B was also required to provide Ms A with a written apology.
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