Posted: 03 Mar 2010 07:34 AM PST

TORONTO -- Years of vigilance, breast self-exams and regular mammograms led Laurie Johnston to Dr. Barbara Heartwell after a routine checkup detected something suspicious.

The 44-year-old Leamington mother believed she was in the hands of a good surgeon who would help her fight off breast cancer, a disease that also struck her mother and sister.

Instead, Johnston says she walked out of Heartwell's office a "disfigured," and forever-changed woman — for no reason.

Johnston underwent radical surgery last fall in which Heartwell removed her left breast and six lymph nodes, only to find out she never had cancer.

Nearly four months after the unnecessary mastectomy was performed at Hotel-Dieu Grace Hospital, Johnston launched a $2.2-million lawsuit against Heartwell, pathologist Dr. Olive Williams, Hotel-Dieu and Leamington District Memorial hospitals.

Johnston is seeking $1 million in general and special damages and another $1 million in punitive and aggravated damages. Her daughters, aged 22 and 15, and her sister are seeking another $200,000 in damages under the Family Law Act.

"To learn that my breast was removed unnecessarily is devastating for me and (my family)," Johnston told a throng of reporters Wednesday at the office of Toronto law firm Torkin Manes LLP.

"Sometimes, I'm alone and I just sit there and think about it, and I start to cry,'' she said. "If I'm not crying, I'm angry, I'm anxious."

The lawsuit, filed Tuesday in Windsor, alleges Heartwell failed to properly diagnose Johnston and "failed to read or properly understand" the pathology report which showed Johnston's lump was benign.

The suit also alleges Williams, who examined Johnston's biopsy samples taken at Leamington hospital, produced a confusing pathology report which contributed to Heartwell's error. The allegations have not been proven in court.

Hotel-Dieu officials have said that Williams's pathology report was correct but that Heartwell misread it. The top of the report lists a clinical diagnosis of ductal carcinoma, based on initial findings. Further down the page, Williams listed a pathological diagnosis of fibroadenoma — a benign growth in the breast.

Johnston's lawyer, Barbara MacFarlane, said Hotel-Dieu ought to have known at the time of Johnston's surgery that Heartwell had performed another unnecessary mastectomy in 2001 on Janice Laporte, who was cancer-free.

Laporte, who now lives in Sarnia, came forward with her story after hearing about Johnston in the media. Laporte settled a lawsuit against Heartwell out of court. That suit did not name Hotel-Dieu.

MacFarlane said both Hotel-Dieu and Leamington hospitals should have known that Williams was "incompetent." Hotel-Dieu began reviewing Williams's pathology reports in November, after she made an error that seriously harmed a patient at the hospital. Hotel-Dieu hasn't revealed what happened to that patient.

Williams was suspended Jan. 4. Heartwell voluntarily stopped performing surgeries at Hotel-Dieu last week. The hospital is also reviewing her past cases.

Both physicians are under investigation by the College of Physicians and Surgeons of Ontario. The Ontario Ministry of Health has also launched a probe into surgical and pathology errors in Windsor.

Heartwell's London lawyer, Andrea Plumb, said Wednesday she couldn't comment on Johnston's lawsuit. It wasn't known if Williams has retained a lawyer.

In a statement, Hotel-Dieu said it has not yet received official notice of Johnston's claim.

"We are profoundly sorry that this tragic situation has occurred and we know this is an extremely difficult time for Ms. Johnston," hospital CEO Warren Chant said, adding that Hotel-Dieu has offered support to Johnston and "will we will continue to do so."

But Johnston said she felt the hospital's patient advocate was "digging for information" in their conversations, which made her feel uncomfortable.

Johnston recounted Wednesday the moment Heartwell told her she'd made a mistake in removing her breast.

"I was almost to the point of fainting in her office," she said.

Johnston said she left the appointment "numb and confused," wondering if Heartwell was mistaken and she actually did have cancer. Johnston pushed for a second opinion on her pathology results and eventually got one from Mount Sinai Hospital in Toronto, confirming there was no malignancy.

Johnston said she didn't ask for a second opinion before Heartwell scheduled the mastectomy because she believed her tests were correct and "efficient."

She also didn't report Heartwell's mistake to Hotel-Dieu because she believed the surgeon would do so herself.

"I felt that was her duty," she said.

Hotel-Dieu has said it wasn't aware of Johnston's case until Feb. 5., when a local reporter called with questions about the mastectomy.

Johnston said having her breast removed unnecessarily has changed everything — from the way she dresses to how she interacts with people.

"I'm withdrawn now," she said. "The phone will be ringing and I'll look at it and I can't answer it. I don't want to talk to anybody."

Johnston said she used to relish spending time with her family and friends and loved her job at Cavendish Farms in Wheatley. But she hasn't been able to work since the mastectomy and doesn't think she could ever return to the physically demanding job.

Johnston said she hopes her lawsuit will not only bring her justice, but also help prevent other women from going through the same thing.

"I would like to assist in making changes," she said.

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Most early-stage breast cancer patients may not need radiation after mastectomy - EurekAlert

Posted: 06 Mar 2010 05:50 AM PST

Public release date: 6-Mar-2010
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Contact: Lindsay Anderson
lindsay.anderson@gabbe.com
212-220-4444
University of Texas M. D. Anderson Cancer Center

No significant increased risk of recurrence for women with spread to 1 lymph node, compared to others without metastasis

St. Louis, MO - Breast cancer patients with early stage disease that has spread to only one lymph node may not benefit from radiation after mastectomy, because of the low present-day risk of recurrence following modern surgery and systemic therapy, a finding that could one day change the course of treatment for thousands of women diagnosed each year, according to researchers at The University of Texas M. D. Anderson Cancer.

The research, presented today in the plenary session of the Society of Surgical Oncology Annual Cancer Symposium, showed that stage I and II patients without spread to axillary lymph nodes or with 1-3 lymph nodes with metastasis who received surgery and adjuvant chemotherapy without radiation to the chestwall post-mastectomy had a low overall risk of locoregional recurrences (LRR).

According to Henry Kuerer, M.D., Ph.D., professor and Training Program Director in M. D. Anderson's Department of Surgical Oncology, 90 percent of patients diagnosed with node-positive disease will present with three or fewer nodes. An estimated 47,000 women are diagnosed annually with breast cancer involving 1- 3 lymph nodes. Of those, 30,000 have only one lymph node involvement.

"There is currently no question that radiotherapy after mastectomy is effective at decreasing the chances of LRR and is indicated in breast cancer patients with lymph node spread in greater than four nodes and where the risk of LRR is higher than 10 to 15 percent. However, the need for post-mastectomy radiation in early stage breast cancer patients has been a topic of great debate within the cancer community for decades," explained Kuerer, the study's senior author.

In the 1990s, two landmark randomized trials demonstrated a survival benefit for early stage breast cancer patients with lymph node metastases who received the therapy post-mastectomy, explained Kuerer. Subsequently, in 2005, a meta-analysis of randomized clinical trials that were conducted in the 1960s to 1980s showed both a survival benefit, and a decreased risk of LRR for women with node positive breast cancer. These study findings shifted clinical practice: the National Comprehensive Cancer Network altered their medical guidelines in 2007 to suggest that stage I and II breast cancer patients with one to three lymph node metastases "strongly consider" radiation post-mastectomy.

"We have entered a new era of breast cancer diagnosis and treatment. Modern day advances in all modalities have been dramatic and, collaboratively, have had a significant impact on recurrence and survival. Given these advances, the goal of our study was to assess the present-day LRR risk in women who present with smaller breast tumors and metastases to fewer lymph nodes," said Kuerer.

Kuerer and his colleagues studied clinical and pathological factors from 1,022 stage I or II breast cancer patients who received a mastectomy at M. D. Anderson between 1997 and 2002. Of those women, 79 percent had no lymph node involvement, 26 percent had 1-3 positive lymph nodes, with the majority having just one positive node. None received post-mastectomy radiation and/or pre-operative chemotherapy; 77 percent received post-operative chemotherapy and/or hormonal therapy. The median age was 54 years and the median follow up time was 7.5 years.

The researchers found that there was no statistical difference in the 10-year risk of LRR in women without lymph node spread versus those with spread to one node - 2.1 percent to 3.3 percent, respectively.

The only independent risk factor for LRR was age; patients age 40 and younger, regardless of node involvement, were at significant increased risk for LRR.

"For these younger women, not less, but more treatment may be needed," said Rajna Sharma, M.D., a fellow in M. D. Anderson's Department of Surgical Oncology, who presented the findings.

"For the overwhelming majority of early-stage breast cancer patients treated with modern surgery and systemic therapies, LRR rates may be too low to justify routine use of post-mastectomy radiation," said Kuerer. "This research will provoke much discussion among those caring for women with early-stage breast disease. Replicating these findings should be a priority to ensure that patients only receive therapy that is medically necessary."

In addition to Kuerer and Sharma, other authors on the all-M.D. Anderson study include: Thomas A. Buchholz, M.D., professor, Department of Radiation Oncology; Funda Meric-Bernstam, M.D., professor, Kelly K. Hunt, M.D., professor, Isabelle Bedrosian, M.D., assistant professor, Gildy V. Babiera, M.D., associate professor, Anthony Lucci, M.D., associate professor, Rosa F. Hwang, M.D., assistant professor, Loren L. Rourke, MD., assistant professor, Elizabeth A. Mittendorf, M.D., assistant professor, all in the Department of Surgical Oncology; Steven J. Kronowitz, M.D., associate professor, Department of Plastic Surgery; 4 Savitri Krishnamurthy, M.D., professor, Department of Pathology; Ana M. Gonzalez-Angulo, M.D., associate professor, Department of Breast Medical Oncology; and Wei Qiao, Department of Biostatistics.

About M. D. Anderson

The University of Texas M. D. Anderson Cancer Center in Houston ranks as one of the world's most respected centers focused on cancer patient care, research, education and prevention. M. D. Anderson is one of only 41 Comprehensive Cancer Centers designated by the National Cancer Institute. For four of the past six years, M. D. Anderson has ranked No. 1 in cancer care in "America's Best Hospitals," a survey published annually in U.S. News and World Report.

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Breast cancer treatment may involve Acupuncture - Top News India

Posted: 05 Mar 2010 12:51 AM PST

Breast cancer treatment may involve Acupuncture According to a new study, acupuncture could be an effective therapy for joint pain and stiffness in breast cancer patients who are being treated with commonly used hormonal therapies.

Researchers at the Herbert Irving Comprehensive Cancer Center at New York-Presbyterian Hospital/Columbia University Medical Center, led the new study which found that joint pain and stiffness are common side effects of aromatase inhibitor therapy, in which the synthesis of estrogen is blocked.

It was previously shown that the therapy, which is a common and effective treatment for early-stage, hormone-receptor-positive breast cancer in post-menopausal women, causes some joint pain and stiffness in half of women being treated.

Dr. Dawn Hershman, senior author of the paper said," Since aromatase inhibitors have become an increasingly popular treatment option for some breast cancer patients, we aimed to find a non-drug option to manage the joint issues they often create, thereby improving quality of life and reducing the likelihood that patients would discontinue this potentially life-saving treatment."

43 women were randomly assigned by researchers to receive either true acupuncture or sham acupuncture twice a week for six weeks, to explore the effects of acupuncture on aromatase inhibitor-associated joint pain.

Dr. Katherine D. Crew, first author of the paper said," This study suggests that acupuncture may help women manage the joint pain and stiffness that can accompany aromatase inhibitor treatment." She further added," To our knowledge, this is the first randomized, placebo-controlled trial establishing that acupuncture may be an effective method to relieve joint problems caused by these medications. However, results still need to be confirmed in larger, multicenter studies." (With Input From Agencies)

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Breast Cancer

Monday, March 8, 2010

plus 2, Surgeon, pathologist, 2 hospitals named in $2.2M mistaken mastectomy ... - Windsor Star

plus 2, Surgeon, pathologist, 2 hospitals named in $2.2M mistaken mastectomy ... - Windsor Star

No significant increased risk of recurrence for women with spread to 1 lymph node, compared to others without metastasis

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