The implementation of new guidelines for the assessment of breast cancer, based on treatment in dedicated breast cancer units, would have significantly reduced the risk of misdiagnosis for Rebecca O'Malley, medical sources have suggested. Dr Muiris Houston, Medical Correspondent, reports.
New quality assurance standards for breast cancer, to be launched today by the Minister for Health, Mary Harney, call for the establishment of a network of specialist breast centres, each caring for a minimum of 150 newly-diagnosed patients with breast cancer each year.
The report of the National Quality Assurance Group for Symptomatic Breast Disease Services, which has been seen by The Irish Times, says that the diagnosis of breast cancer must be based on a system of triple assessment, encompassing clinical examination, radiography in the form of a mammogram or an ultrasound, and the analysis of biopsy specimens.
The report emphasises that the results of all three assessments should be discussed at a multi-disciplinary team meeting attended by all specialists involved in the patient's care.
Mrs O'Malley, who was told she had breast cancer 14 months after getting the all-clear following the assessment of a breast lump, was treated in at least two different hospitals. It is understood that she had a clinical assessment in Limerick Regional Hospital and that her biopsy specimen was analysed at Cork University Hospital.
Under the new guidelines, she would have received all her care at a single facility, staffed by at least two consultant breast surgeons, two specialist radiologists, a team of specialist nurses and at least two consultants with an expertise in breast pathology.
Medical sources indicated that while no system can guarantee perfection, the risk of a misdiagnosis would be "minimised" by patients attending fully-resourced, specialist breast centres.
The report recommends that each centre provide a service to a population of 300,000- 350,000, indicating the need for about 12 specialist breast centres in the State. "The nomination and designation of centres should be announced without further delay and resources [ should be] allocated immediately to support each centre."
The report defines quality measures for each speciality involved in breast cancer care. "Individual consultant surgeons must treat a minimum of 50 and a maximum of 150 new patients with breast cancer per year."
It says that breast pathology reports must contain a minimum amount of data, as set out by the faculty of pathology of the Royal College of Physicians in Ireland (RCPI). The report adds that all consultant pathologists involved in breast tissue analysis must participate in a quality assurance programme.
"It is recommended that a meeting of representatives from all specialist breast centres be convened at least annually so that the performance of each centre can be assessed and compared."
Last night, Prof Niall O'Higgins, the chairman of the breast disease quality assurance group, said: "This is a robust set of clinical standards that should be adopted and applied everywhere. It will reassure patients and drive standards upwards. I would like to see the model applied to other cancers in the future."