The reassurance offered by the radiologist rang hollow to Sylvie Marotte as she sat in the doctor's office worried about the hard little ball in her left breast.
Just a nasty bruise deep inside the tissue, Raymond Bergeron told the young woman in the fall of 2009. She had, after all, recently been struck by a heavy box at the packaging factory where she worked. "My first instinct was that it all seemed very odd. His manner was that of a very old man, a bit lost. Slow and nonchalant. I had my doubts from the start," said Ms. Marotte, now 39. She was billed $80 for the test at Dr. Bergeron's private clinic.
Ms. Marotte's fears came true a few months later, when a second opinion led to a diagnosis of an aggressive form of breast cancer that has moved swiftly to other organs. Her doubts about Dr. Bergeron were emphatically confirmed on Tuesday, when the Quebec College of Physicians and Surgeons revealed in an 83-page report that the doctor missed dozens of cancer diagnoses in other women.
A review of more than 22,000 mammograms performed between 2008 and 2010 found Dr. Bergeron was responsible for 96 missed cancer diagnoses, putting his rate of error five times above provincially accepted levels. (Thirteen other cases at clinics where he worked were found to be mistakes by other doctors, but within norms.)
Errors in breast cancer screening and follow-up tests have become a recurring problem in Canadian health care. Misread scans by radiologists and improper tissue testing by pathologists in Newfoundland, Ontario, Saskatchewan and British Columbia have caused immense anxiety among patients, and it is difficult to determine how many people died as a result. In the current Quebec case, no deaths can yet be attributed to the errors, but many patients remain in treatment.
Attempts to reach Dr. Bergeron on Tuesday were unsuccessful.
Cancer screening is far from an exact science with black-and-white answers, according to Yves Robert, secretary of the College of Physicians.
"They're looking for a snowflake in a snowstorm. It takes an incredible amount of expertise to find it, and you can always miss something. That's why it's important to have breast cancer screening every two years," Dr. Robert said.
The report said Dr. Bergeron, who is in his mid-70s and retired as the review began, kept incoherent files and notes, carried a workload that was too heavy, and failed to follow provincial standards at his private clinics.
Dr. Bergeron, like many Quebec radiologists, was operating outside the provincial breast cancer screening program, which helps promote professional standards for tests, said Frédéric Desjardins, president of the Quebec association of radiologists.
"He also had a certain professional isolation, which happens in many practices as physicians approach the end of their careers," Dr. Desjardins said. "They are susceptible to having deficiencies in their practice. It's not a question of age, but the tendency to work alone as doctors get older."
The review panel made 10 recommendations to prevent similar errors, chiefly to beef up standards for mammography and to improve record-keeping and oversight of radiologists. At least a dozen lawsuits have been filed, are pending or have been settled.
In November, 2010, the college received the first reports of problematic testing at the Fabreville, Jean-Talon-Bélanger and Domus Medica clinics in Montreal and the surrounding suburbs where Dr. Bergeron practiced.
It was one year earlier that Ms. Marotte walked into the Fabreville clinic. She had an extensive family history of breast cancer, which didn't seem to bother Dr. Bergeron, she said.
When she went for the second opinion a few months later, doctors immediately rushed to treat her. On the scan done by Dr. Bergeron, doctors could immediately see "a large thick tumour," according to her medical records.
Her breast was removed, but the cancer spread to her brain. She had brain surgery to remove a tumour, and now others have infiltrated along her spine. "All the treatments I received in 2010, the chemo, radiation, it did nothing. It was all for nothing. I suffered for nothing," she said.
She and her husband, Jean-Luc Couture, are convinced an earlier diagnosis might have meant another outcome. "Instead, she's going to live out her days heavily medicated," Mr. Couture said.
Ms. Marotte says she's angry and may launch her own lawsuit, but it's unlikely to be resolved in the time she has left. She passes her days trying to do a little housework and find comfort. "There's nothing left to be done now but wait."