Dr. Alan Kwan told the Cameron inquiry he and other physicians should have been told about 2003 warnings about the reliability of cancer tests. (CBC)

A surgeon has told Newfoundland and Labrador's breast cancer inquiry that warnings about a pathology lab should have gone out further and earlier than they did.

Dr. Alan Kwan, who performs surgeries on dozens of breast cancer patients each year, told the Cameron inquiry Monday that he works closely with pathologists and oncologists at Eastern Health.

Nonetheless, Kwan testified, he was not aware in 2003 that St. John's pathologist Gershon Ejeckam had written dire warnings about unreliable results with hormone receptor tests.

The tests are used to help determine whether a breast cancer patient can benefit from antihormonal therapy, primarily the potent drug Tamoxifen.

Asked by inquiry co-counsel Bern Coffey if he felt Ejeckam's warnings should have been brought to his attention, Kwan replied, "I think it should've been brought to the whole hospital's attention."

Kwan is the latest witness to tell Justice Margaret Cameron about not knowing about Ejeckam's warnings, which led to parts of the St. John's pathology lab being temporarily shut down.

Earlier this month, for instance, oncologist Joy McCarthy testified she too did not know about Ejeckam's concerns, even though she specializes in working with breast cancer patients.

Memo warned superiors about test problems

In June, Ejeckam — who retired from Eastern Health in 2006 and who now lives in Nigeria — told the inquiry that Terry Gulliver, a lab manager, had said he would organize a meeting "for all the stakeholders to discuss it." Ejeckam said the meeting never happened, although some problems at the lab were dealt with. Gulliver is scheduled to testify at the inquiry later this week.

Ejeckam's key memo warned superiors that problems with lab tests could be putting patients at risk, and that the St. John's Health Care Corp. — which merged with other authorities in early 2005 to form Eastern Health — could be sued.

Kwan also told the inquiry that he was also not told about an external review that identified serious problems with how the pathology lab was functioning.

When Coffey asked Kwan if he had been shown the 2005 findings of B.C. pathologist Diponkar Banerjee — one of two external experts recruited by Eastern Health to review the pathology lab — Kwan replied that he did not even know that Banerjee had visited the hospital.

Cameron, a justice on the Newfoundland Supreme Court of Appeal, has been hearing evidence since March about how hundreds of breast cancer patients received faulty test results between 1997 and 2005, and about how officials responded to the crisis.