During my career as a clinical negligence solicitor I have been lucky enough to work with some extraordinary former patients and to successfully pursue claims for them stemming from a delay in the diagnosis of cancer. I am proud to have developed a reputation as an expert in this area and, because of this, feel well placed to write a series of blogs about cancer and clinical negligence cases.
This first blog, on cervical cancer, may be one of the most important, because this type of cancer is preventable, with early detection and treatment. Sadly, delays in detection and treatment do occur and, in these circumstances, if cancer develops, much more extensive treatment may be required.
What is Cervical Cancer?
Cervical cancer develops in a woman’s cervix, the entrance to the womb. There are often no symptoms during the early phases of cervical cancer but, if there are, these may include vaginal bleeding; particularly after sex, in between periods or after the menopause.
Cervical cancer only develops when there is a change in the DNA cells in the cervix, which is almost exclusively caused by the human papilloma virus. The DNA change, or mutation, alters the control of the cell growth, resulting in the cells reproducing uncontrollably leading to a lump – a tumour.
How is it detected?
If you are suffering vaginal bleeding, discharge and/or cramping your doctor should refer you to a specialist, within two weeks, for further investigation. If there are no symptoms, as is often the case, routine cervical screening tests (smear tests) may be the first opportunity to identify suspicious cells.
These tests work by taking a sample of cells from the cervix for examination under a microscope to look for abnormalities. Reassuringly, in most cases, finding abnormal cells does not mean cancer. There are instead other more common causes, including infection and pre-cancerous cells. If pre-cancerous cells are found they should be removed to prevent their development into cancer cells.
Under the NHS Cervical Screening Programme all women registered with a GP are invited to attend cervical screening tests. The frequency of testing depends on the woman’s age:
- 25-49, tested every 3 years;
- 50-64, test every 5 years; and
- 65 plus, only those who have not been screened since age 50 or had recent abnormal tests.
Since this programme was introduced in the 1980s, the number of cervical cancer cases has decreased by about 7% each year. Cervical cancer cases have overall decreased by 46% since the late 1970s in Great Britain. Despite this general positive trend, within the last decade, the number of cases involving young women has been on the increase.
Who does it affect?
A lot has been written about who cervical cancer affects. Some of this is confusing. For example, earlier this year, the BBC wrote about a British Medical Journal report that said this is not just a younger woman’s disease and, in fact, half of deaths occur in woman over 65. It is important to present the full picture, however, because over three-quarters of all new cases of cervical cancer are diagnosed in women aged 25-64 and cervical cancer is the most common cancer in females under the age of 35 in the UK (worldwide, there were 527,000 women diagnosed in 2012).
The purpose of the BMJ report was quite rightly to make the point that cervical cancer, although more common in younger women, increasingly affects women of all ages and, accordingly, they put forward a proposal that the age limit for cervical cancer screening should be raised to 70.
The risk to women, of all ages, has been widely publicised in recent years. Jo’s Cervical Cancer Trust has, for example, reported some alarming statistics. In 2012-13 more than one-third of women aged 25 to 29 did not attend routine cervical screening tests. One-quarter of 60 to 64 year old women also failed to attended for tests in the same year.
The Chief Executive of the Trust, Robert Music said: “Annually one in five women in the UK will fail to attend cervical screening. Our data revealed that on average across the UK young women delay screening for 15 months and 60-64 year olds delay for 33 months”.
The message is clear; make time to attend these tests because early detection is crucial.
What are the treatment options?
The treatment options are dependent on the stage at which cancer has been diagnosed and whether it has spread elsewhere. If cervical cancer is diagnosed at an early stage, treatment may include surgery to remove the womb and/or radiotherapy. If cervical cancer is only diagnosed at a late stage, treatment may include radiotherapy, chemotherapy and possibly also surgery.
It goes without saying, the chances of a complete cure are much higher if the cancer is diagnosed early and, crucially, before it spreads. If cervical cancer is not curable, palliative care is likely.
Almost 63% of women diagnosed with cervical cancer in England survived for ten years or more between 2010-2011. When diagnosed at its earliest stage, around 95% of women will survive the disease for 5 or more years compared with 5% diagnosed with the disease at the latest stage.
When things go wrong?
Time is of the essence in diagnosing cervical cancer. As the statistics above illustrate, early detection and treatment really does save lives. The detection system does unfortunately break down and in these circumstances there may be a clinical negligence claim for compensation as a result.
The first example of such a negligence claim involved a young women who complained to her GP about vaginal bleeding. Her GP arranged for a cervical screening test but despite the concerning symptoms, did not refer the woman to a specialist unit for further investigation and treatment. The cervical screening test result came back 2 and a half month’s later indicating borderline changes to the cells in the cervix. The GP again did not refer the women. Finally, after months of further delay, the woman was seen at Accident and Emergency where cervical cancer was diagnosed.
The cancer had developed into a large tumour meaning that the woman required extensive chemotherapy and radiotherapy which made her infertile, as well as other physical and psychological injuries. After investigation, both the GP and the Hospital involved admitted their treatment fell below a reasonable standard of care and the delay in diagnosis caused the young woman severe injury and loss. The claim for damages settled for a sum in excess of £500,000.
The second example involved a woman who attended cervical screening tests over the course of a number of years. Initially, she was not suffering from any symptoms that might have raised suspicion of cervical cancer and the results of the screening tests, 3 years apart, were reported as normal. The woman then started to suffer from vaginal bleeding and pain. Her GP rightly referred her to a specialist clinic for further investigations and she was subsequently diagnosed with cervical cancer and required a hysterectomy which, of course, meant that she could not have children.
The cervical screening tests were re-examined and it was found that they had been incorrectly interpreted; they did, in fact, reveal cell abnormality. The Defendant Hospital Trust admitted liability and, specifically, that had the tests been correctly interpreted and reported it was likely that the woman would have received treatment before cervical cancer developed and would not have required a hysterectomy. The claim for damages settled for a 5 figure sum.
If you think you, or someone you know, may have suffered an injury as a result of a delayed diagnosis of cervical cancer or other negligent medical treatment and would like to speak with a member of the clinical negligence team, please call on 0113 245 8549.
The author of this blog is Susan Bartfield, with assistance from Guy Pomphrey.