Woman dies after cancer miss

A 49-year-old Kiwi woman died after her GP “assumed” a painful swollen lump in her right breast was not cancer.

An investigation by the Health and Disability Commission found the doctor in breach for failing to refer the woman, who has not been named, to a specialist for further testing.

“There were clear indications to refer the woman for further imaging of her breast lesion and was critical that the first GP failed to do so,” Health and Disability Commissioner Anthony Hill said.

The failings started in September 2015, when the woman visited her GP after breast pain and swelling in the previous two to three days.

The doctor found a 3cm cyst but it was in the same area as a faint lesion that had appeared in a previous mammogram as not cancerous, so assumed it was nothing new and did not make a referral for further testing. He said to come back if symptoms persisted, the decision released yesterday shows.

Five months later, the woman returned and was examined by a different doctor at the medical centre. The GP made an urgent referral to a specialist. Only then was the woman diagnosed with advanced breast cancer, but it was too late and she died.

Hill said by failing to refer her for further imaging of the lump, the GP failed to provide services with reasonable care and skill.

The investigation discovered the medical centre did not have its own formal policies and protocols regarding clinical examinations, documentation of consultations or referrals. Instead, doctors had access to a database called HealthPathways which guided management of situations similar to this woman’s case.

The commissioner told the doctor to apologise to the family. The GP has also been ordered to report back to the Health and Disability Commission after further training and any changes the practice has made as a result of the case.

The Herald understands the GP is still practising.