Lack of further investigations into the lump behind her nipple in November 2022
25. Before we decide if we should conduct a detailed investigation of a complaint, we look at whether there are signs the organisation has got something wrong. We do this by comparing what should have happened with what did happen. We have done this and have not found any indications that something has gone wrong.
26. Mrs I explained that when she had her first appointment at the Trust for the lump on 16 November 2022 she was given a mammogram and a ultrasound scan. She was told that these scans showed no indications of any cancer.
27. Mrs I’s cancer was confirmed in February 2023 by a punch biopsy. Mrs I feels, had the Trust given her a punch biopsy in November 2022, her cancer could have been diagnosed sooner.
28. The guidance on diagnosis of breast cancer says for people having investigations for breast cancer an ultrasound evaluation should be performed. It then goes on to say only if abnormal nodes are identified should a ultrasound guided needle sample be carried out. This is where a sample of the suspicious tissue is taken to test it for cancer.
29. Our adviser explained the ultrasound performed on 16 November 2022 showed findings consistent with a benign cyst. They explained it is not necessary for trusts to carry out further investigations following scans with results such as Mrs I.
30. They further explained, when Mrs I returned to the Trust in February 2023, it was necessary for them to carry out a punch biopsy, as the lump had changed in it’s appearance.
31. We see no indications of failings on this complaint component. As Mrs I’s ultrasound scan on 16 November 2022 did not show any evidence of any abnormalities, the Trust were acting in line with the guidance on the diagnosis of breast cancer in not offering her a punch biopsy or similar at that time. We will therefore be taking no further action on this part of the complaint.
Behaviour of staff during her November 2022 appointment
32. Before we decide if we should conduct a detailed investigation of a complaint, we look at whether there are signs the event complained about had a negative effect which the organisation has not put right. Having done so we have found the Trust has already done enough to put right the impact of these events.
33. Mrs I explained during her appointment on 16 November 2022 she heard a member of staff say, “you will need a magnifying glass for this one” and laughing when talking to a colleague about the lump on her nipple. Mrs I explained this made her feel uncomfortable and dismissed.
34. In its complaint response dated 11 March 2024 the Trust apologised for the behaviour of the staff during Mrs I’s appointment. It explained the Clinical Lead for Breast Imaging at the Trust has reminded all staff of the importance of being mindful and respectful of their actions as these can have a profound effect on patients.
35. Our principles for remedy explain that the type of remedy we look to achieve should be appropriate and proportionate to the injustice sustained and should consider the impact the injustice has had on the individual.
36. We recognise the comments made during Mrs I’s appointment will have made her feel uncomfortable and dismissed. We feel the apology provided and the learning identified by the Trust is enough to remedy an injustice of this kind. We will be taking no further action on this part of the complaint.
Lack of routine MRI’s
37. Before we decide if we should conduct a detailed investigation of a complaint, we look at whether there are signs the organisation has got something wrong. We do this by comparing what should have happened with what did happen. We have done this and have not found any indications that something has gone wrong.
38. Mrs I explained that following the end of her cancer treatment, the Trust offered her routine follow up mammograms for the next five years.
39. Mrs I feels the Trust should have offered her routine follow up MRI’s considering when the breast cancer was diagnosed in February 2023, it could not be seen on mammograms.
40. The guidance on breast cancer diagnosis explains the current recommendation is for women to be offered mammograms for the five years following breast cancer treatment. It then continues to say that MRI’s may also be considered, however research is ongoing into the effectiveness of these in identifying breast cancers.
41. Our adviser explained MRI’s may be considered in cases where women have breast cancers that cannot be seen on mammograms such as in Mrs I’s case.
42. Our adviser provided us with a research paper which states early evidence suggests MRI is the most accurate test for detecting breast cancer. Further studies are needed to determine its clinical utility and cost-effectiveness. It states MRI’s may be considered in patients with cancers which cannot be seen on mammograms. This supports our adviser’s position.
43. We saw no evidence the Trust had considered the type of breast cancer Mrs I had when deciding on the type of follow up it offered her.
44. We asked the Trust to reconsider Mrs I’s treatment plan, taking into account the type of breast cancer she had and provide her with a response that reflects this reconsideration.
45. On 4 February 2025 the Trust provided a response which explained it does not offer patients routine MRI’s even in cancers not seen on mammograms. It explained this is because MRI’s generate a “significant benign biopsy rate” and “MRI imaging would trigger significant investigations for benign breast lesions, causing distress to patients, whilst not detecting any further breast cancers”.
46. We asked our adviser if the reasoning the Trust provided for not offering Mrs I routine MRI’s is valid. Our adviser reiterated the guidance suggests consideration of MRI for monitoring. It does not require Trusts to carry out MRIs. In order to be in line with the guidance, the Trust needed to consider the breast cancer was not visible on mammograms. We have found the Trust’s response from 4 February 2025 does this. As the Trust have now resolved this issue, we will be taking no further action on this part of Mrs I’s complaint.
47. In summary, we have found no indications anything went wrong with Mrs I’s follow up care. We recognise it is distressing for Mrs I to not have confidence that any breast cancers will be seen on mammograms, however have come to the conclusion that the Trust have followed the relevant guidance in considering and making the decision to not offer her MRI’s. We hope this statement clearly explains the reasons for our decision.