The High Court has rejected a woman’s claim that a lump examined at Letterkenny University Hospital in May 2017 was the breast cancer diagnosed five months later, finding the lump was probably a cyst.
In a judgment delivered on 14 March 2023, Ms Justice Mary Rose Gearty said the plaintiff had not proved that the pea-sized lump was a tumour or that it was the same entity as the cancer found in October. The court accepted that cancer was probably present in May, but said it was probably undetectable at that time.
The plaintiff, Catriona Crumlish, sued the Health Service Executive, alleging that hospital staff failed to diagnose her cancer in May. She argued that the lump should have been aspirated and that the clinical and radiological assessments were not concordant, prompting further investigation. She said earlier diagnosis would have avoided lymph-node removal surgery and related harm, and sought damages including for pain, lost earnings, childcare costs and loss of pension entitlements.
The court heard that the clinician assessed a palpable lump as S3, or indeterminate, while the radiologist gave the findings an R2 rating, indicating benign features. The radiologist reported multiple small cysts, including one measuring 12mm, in the marked area. The court found he had examined that area and probably saw what his report described. It said the evidence supported a conclusion that the 12mm cyst caused the 15mm lump felt on clinical examination.
The plaintiff relied on an academic paper about breast tumour growth to argue that the cancer would have measured about 15mm in May. The judge preferred the defence expert’s evidence that the paper’s data could not reliably estimate the size of an individual tumour at an earlier date. The study covered cancers visible on two mammograms and did not account for the fastest-growing cancers that might not have appeared on an earlier scan. The court also found no sufficient basis to select the 45-day doubling time used by the plaintiff’s expert.
The judge concluded that the lump was probably a simple cyst, while a separate cancer in the same breast quadrant continued to grow. The plaintiff’s allegations about aspiration and concordance therefore did not need to be decided. The court made no finding that those alleged failures amounted to negligence, and said it would not consider them because the plaintiff had not proved the lump was the tumour. The parties are to be heard on costs.