Winnipeg man mistakenly diagnosed with cancer
Policy at private lab changes shortly after patient undergoes needless surgery
A University of Manitoba student says he was incorrectly diagnosed with cancer after having a mole removed by his family doctor.
Myles Keleher went to his doctor in spring 2015 to have a mole on his arm removed. His doctor removed the mole and sent a sample for a biopsy. When Keleher returned to his doctor a few weeks later for an unrelated matter, he was told the results were in, and that he had cancer.
"He goes, 'Oh yeah, I got those results back from those moles I removed, and one of them turns out to be cancerous,'" said Keleher, 22.
The sample had been sent to Dynacare, a private lab. A pathologist reviewed the sample and reported it was malignant melanoma.
The day after receiving the news from his doctor, Keleher got a call from CancerCare Manitoba. He was referred to a surgeon, who operated on him within two weeks of the cancer diagnosis.
The surgeon cut out a section of his arm surrounding the area where the mole had been removed. A piece of his lymph node under his arm was also taken for a biopsy to check if the cancer had spread.
One month after surgery, Keleher met with the surgeon and was informed not only had the cancer not spread, but there was never any cancer to begin with, he said.
"[She said] the good news is you don't have cancer. There's no cancer, and there never was.… The bad news is that this happened, that there was this misdiagnosis," said Joan Hreno, Keleher's mother.
Dynacare, in a statement to CBC, said the results they provide are prepared in their lab for review by a pathologist.
"The pathologists are not employees of our company. They are independent contractors, many of whom may also work for Diagnostic Services of Manitoba Laboratories," the statement says.
"Once the pathologist has provided his/her report on a case, we report that result back to the ordering physician."
Diagnoses are determined by the doctors involved in the treatment of the patient, as well as the pathologist, Dynacare's statement says.
"It is up to the ordering physician, surgeon and pathologist to seek a second opinion depending on the full medical history of a particular patient. It's also a patient's right to speak with her or his treating physician to determine if another opinion may be warranted," said the statement from Dynacare.
CancerCare said it is not standard procedure to ask for a second pathology report unless the oncologist has a reason to question it.
"If it is something that looks unusual we discuss, and then pathology gets reviewed. But do you question whether each cancer patients [results] are looked at by two separate pathologists? No," said Dr. Sri Navaratnam, president and CEO of CancerCare Manitoba.
In a letter responding to the complaint filed by Keleher, the original pathologist who interpreted the results from Dynacare states "the lesion was incompletely excised" and had "characteristics associated with malignant melanoma."
But the letter goes on to state that after the surgery, and after it was discovered that Keleher didn't have cancer, the pathologist went back and re-examined the initial specimen and asked for further consultation from two other dermatopathologists.
"The more appropriate diagnosis, on review, was a deep penetrating nevus," the original pathologist states in the letter.
Keleher is upset that second opinions were not sought before he underwent painful surgery that prevented him from taking a summer tree-planting job.
Keleher is a student and relied on his summer employment to pay for his tuition.
"I just want to be compensated for the loss of work. I could have gone tree planting and made over $10,000, and instead I sat at home thinking that I was dying of cancer," he said.
Keleher also wants an apology and to be assured that procedures will be reviewed to prevent this kind of thing from happening again.
"Right now, as it's going, no one knows that this happened. What's stopping this from happening again? I couldn't tell you," said Keleher.
Shortly after this incident, Dynacare changed its policies.
"Where a patient is discovered to have a first case/finding of melanoma, we now automatically send that case to be reviewed by another pathologist before a final report is issued," it said in the statement.
'I just feel like it's a lot of passing the buck'
Hreno wants to know why CancerCare acted on the findings of just one pathologist from a private lab and never had a second pathologist review the findings.
"If CancerCare doesn't stand behind Dynacare's pathology reports, why don't they do their own?" said Hreno.
Navaratnam said Cancercare is working on providing more accountability throughout a patient's care from diagnosis to treatment.
"So that we don't have to have this discussion about who is responsible for that quality indicator, or who is responsible for this? We all, at the system, have to come and say 'We own this' and we need to improve this. And that's what we are working towards," said Navaratnam.
Keleher said they were never aware of Dynacare's involvement, and that the tests were sent away by his family doctor.
"Me as the patient, I never hired Dynacare. I relied on them [my doctors] to do the job right, and they didn't," said Keleher.
Lost faith in the medical system
Keleher said the ordeal has not only affected him financially but emotionally.
"It was basically like a midlife crisis, except I'm 22," said Keleher.
"The fact that I thought I was going to die had a really big impact on my personality, the way that I viewed life. If you think you're going to die soon, what do you have to live for?"
Keleher also said it wasn't until he filed a complaint and received the letter from the original pathologist that he found out the correct diagnosis is also something that may need long-term follow up.
"I don't have very much trust in the health system," said Keleher.
Keleher encourages other patients to question the system.
"Always get a second opinion," he said.