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Missed diagnosis of breast cancer (05HDC05429)

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(05HDC05429, 21 December 2005)

General practitioner ~ Breast lump ~ Breast cancer ~ Pregnancy ~ Right 4(1)

A 40-year-old woman complained about care provided by her general practitioner (GP). When she was 21 weeks' pregnant, she visited her midwife for a routine check-up. The midwife found a lump in the woman's left breast and advised her to see her general practitioner.

The woman and her partner attended the consultation, and the GP's notes recorded a three-day history of a painful lump in her left breast. On examination there was a 3cm lump and the GP considered that it was most likely a blocked duct with infection or a tumour. It was his intention to refer her to a breast surgeon if the lump did not respond to a 10-day course of antibiotics and paracetamol, and a further appointment was made for a week later. When they attended the second consultation, the woman advised the GP that there had been some reduction in the size of the lump and that it was not as sore as previously. The GP did not perform an examination, and decided not to make a referral to a specialist until after the birth of the baby.

The couple moved to another city later in the pregnancy, where she told her new midwife that she had a lump in her breast. The woman was immediately referred to the nearest breast screening service, and was seen by a house surgeon, who recorded a fixed hard solid lump measuring 6cm by 4cm. Following a mammography and fine needle cytology, a diagnosis of left breast carcinoma was confirmed.

After the birth of her child she underwent a left mastectomy and axillary dissection. A CT scan confirmed likely metastatic disease and the woman died later that year.

It was held that by not examining the patient at the second consultation, or organising any kind of follow-up check, the GP did not provide services with reasonable care and skill, and breached Right 4(1). Breast cancer in pregnancy is particularly aggressive and needs urgent management.

The GP was referred to the Director of Proceedings, who issued proceedings before the Health Practitioners Disciplinary Tribunal. A charge of professional misconduct was upheld.

 

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