ST. JOHN'S, N.L. - Newfoundland and Labrador health officials have conceded they may never find everyone who was given an incorrect result on their breast cancer test, even as they concluded a rigorous review that identified another 39 cases.
The toll exacted from the province's breast cancer testing scandal grew Thursday after health boards provided an update on the unravelling scandal, announcing that 425 out of 1,088 breast cancer patients were given faulty treatment test results.
"This is as close to a final number as we're going to get," said Vickie Kaminski, CEO of the Eastern Health authority.
"I can't stand here and give you 100 per cent assurance that it is absolutely every person. We may, in fact, come up with one or two or three down the road at some point."
The province's four health authorities released the update after discovering last month that the hormone receptor tests of 65 patients were overlooked in a review of tests done over an eight-year span. That review was conducted to verify the accuracy of hormone receptor tests taken from 1997 to 2005.
Eastern Health, the province's largest health board, said the tests were missed in the review because of incomplete medical file searches, among other reasons.
"We're not convinced that they've found every one of them," said Peter Dawe, executive director of the Newfoundland and Labrador branch of the Canadian Cancer Society.
"That speaks volumes to the absolute mess they had in data management when this whole process began."
Of the 425 patients who had erroneous test results, 127 have died, an increase of 19 since March 2008. But it may never be known how many of them died as a result of missing out on potentially life-saving treatment because of inaccurate tests.
"It is unfortunate," said Paul Oram, the province's health minister.
"Having said that ... I still feel good about the fact that we are now turning the corner here. We've invested several million dollars into our laboratories and Eastern Health has done a good job right now in terms of changing things around and making things better for patients and for people in Newfoundland and Labrador."
Some of the remaining 298 living patients who had their tests botched have since been given different treatment, Kaminski said.
"Everything about this has been startling and difficult and shouldn't be the reason why we look at it," she said. "We should be looking at this because we need to standardize, qualify and appropriately test and diagnose people."
A day earlier, the Canadian Association of Pathologists called for the establishment of national standards for laboratories that examine hormone receptor tests.
Hormone receptor tests play an important role in determining the most appropriate course of treatment for men and women with breast cancer.
If patients are found to be estrogen- and/or progesterone-positive, they may respond to hormone therapy such as Tamoxifen. If not, they may be given a range of other treatments, or no treatment at all, depending on the characteristics of the patient's cancer.
A judicial inquiry into the faulty tests concluded earlier this year that a litany of problems at a St. John's laboratory led to at least 386 breast cancer patients receiving the wrong results on their hormone receptor tests.
A failure of accountability and oversight "at all levels" within the province's health care system led to the mistakes, Justice Margaret Cameron said.
Problems with the testing were detected in the spring of 2005, when doctors began questioning the hormone receptor test results of a patient with invasive lobular carcinoma, a form of breast cancer.
After retesting, it was discovered that the initial test result was wrong, as were those for a small sample of other patients.
Eastern Health subsequently halted testing in its lab and transferred its hormone receptor tests to Mount Sinai Hospital in Toronto. The health board then started a review of all hormone receptor tests from 1997 to 2005.
Kaminski said she hoped the St. John's lab would resume hormone receptor testing in the fall or early winter.
