By Aisling Byrne
The High Court has found that the HSE breached its duty of care when a January 2022 surveillance mammogram at University Hospital Waterford was classified as benign and Áine McSweeney was not recalled for further assessment.
McSweeney, a registered nurse with a strong family history of breast cancer, had been enrolled in periodic breast imaging. Her May 2019 mammogram was assessed as normal. In October 2020, consultant radiologist Dr Carmel Ann Daly identified subtle microcalcifications but classified the study as RCR Category 2, meaning benign and not requiring recall.
Mr Justice Paul Coffey found that the 2020 assessment remained within the range of acceptable professional judgment. At that stage, there were only a small number of subtle microcalcifications, without convincing suspicious distribution or sufficient cumulative features to require intervention.
A further surveillance mammogram was performed in January 2022 and was again classified as RCR Category 2. It was common case that a biopsy at that point would likely have detected cancer or pre-invasive disease.
By May 2023, imaging showed conspicuously malignant features and biopsy confirmed invasive ductal carcinoma.
The court held that the position had materially changed by January 2022. The same focal group of microcalcifications had persisted, become more conspicuous and developed in number and alignment. There were at least four definite calcifications, with a possible fifth, and three or possibly four were aligned on one projection.
Coffey J held that this cumulative picture could no longer support the very high level of professional confidence in benignity required for an RCR Category 2 classification. At minimum, the findings should have been classified as RCR Category 3, meaning indeterminate or probably benign and requiring further investigation.
The court therefore found a breach of duty in January 2022. The trial had been divided into separate modules, and this judgment decided only whether the HSE breached its duty. It did not determine causation, the consequences of the delayed diagnosis or damages.