Radiologist missed 38 breast cancers in two yearsBMJ 2007; 334 doi: https://doi.org/10.1136/bmj.39118.376991.DB (Published 08 February 2007) Cite this as: BMJ 2007;334:281
The delayed diagnoses of breast cancer in 18 women in north Manchester, one of whom has since died of the disease, have been blamed on the “individual failings” of one radiologist.
The doctor missed 38 cancers in two years, but in 20 cases, his colleagues picked up his mistakes.
But a report into the incident, commissioned by the NHS North West Strategic Health Authority, showed that the work of the radiologist went unaudited for 17 months after concerns about him were first raised.
The report, written by Mark Baker, director of the Clinical Centre for Cancer at Leeds Teaching Hospitals NHS Trust, criticises the Trafford Healthcare NHS Trust, one of the two trusts involved, for “weaknesses and lack of leadership in the diagnostic role of the breast multidisciplinary team.”
It shows that no steps were taken to audit the work of Amjad Husien, a consultant radiologist at Trafford Healthcare Trust who also worked locum shifts at North Manchester General Hospital, after concerns about his work were raised by colleagues in November 2003. He continued to work in isolation until April 2005, when his diagnostic mistakes came to light and he was suspended.
In that month, bosses at the strategic health authority ordered a review of nearly 2500 mammograms that had been done at the Trafford and North Manchester General hospitals. More than 150 women were recalled to check their diagnoses and treatment.
Altogether Dr Husien missed 40 breast cancers in the two years that he worked at the hospitals. Out of 24 cancers he missed at Trafford, eight were picked up by other members of the breast cancer team.
Fewer cancers went undetected at North Manchester General Hospital because colleagues in the unit routinely double or triple checked Dr Husien's findings, something that had also happened at previous hospitals at which he had worked. Of 14 cancers that Dr Husien failed to diagnose using mammography at North Manchester General Hospital, 12 were spotted by colleagues.
The 18 women who were wrongly given the all clear were told that because the delay between their having a mammogram and the error being spotted was more than three months their prognosis was “significantly” affected.
Professor Baker concludes, “The precipitating cause of the misreading of the mammograms was the personal failure of a radiologist. However, this was exacerbated by his isolated working in a small imaging department and a generally weak diagnostic setting in the breast service.”
Dr Husien, who is referred to in the report as Dr A, had worked as a consultant for 10 years. He “almost immediately aroused concern” when he took up his post at Trafford General Hospital in April 2003, says Professor Baker.
The errors could have been spotted earlier if a clinical audit of Dr Husien's work had been ordered when colleagues raised these concerns in November that year.
“It is difficult to draw conclusions about the origin of Dr A's clinical failures. It is unlikely, but not impossible, that they coincided with his appointment to THT [Trafford Healthcare NHS Trust],” says Professor Baker. “It is perhaps more likely that they existed prior to his transfer and were masked by the much stronger clinical service setting in which he was working at Stockport and in which he worked at North Manchester.”
The breast screening unit at Trafford, where Dr Husien ran the imaging department single handedly, saw fewer than 100 women a year, below the lower limit recommended by the National Institute for Health and Clinical Excellence for a breast multidisciplinary team. The unit, which has been closed since, “should not be restored,” says the report.
Because of rules on patient confidentially, hospital bosses would not release details about the condition of the 17 other affected women.
Dr Husien has been excluded from work since April 2005 and is being investigated by the General Medical Council.
In a statement released by Greater Manchester Strategic Health Authority last week, Dr Husien said, “I deeply regret any distress or suffering experienced by patients and their relatives arising from this review. I have cooperated fully with the trust during their investigations and continue to do so. As aspects of the investigation are still ongoing, I am unable to comment further at this stage.”
The Baker report is available at www.northwest.nhs.uk/baker.html.