Unnecessary mastectomies: when medical treatment causes harm

Recent reports that 20 women underwent unnecessary mastectomies while being treated for breast cancer at County Durham and Darlington NHS Foundation Trust (CDDFT) have raised serious concerns about patient safety and clinical decision-making.

The women are among hundreds of patients found to have suffered harm during treatment at the Trust’s breast unit. Of 514 cases reviewed by the Trust so far, 315 patients were found to have suffered harm, including 77 who were significantly harmed. The review has also identified cases where cancer diagnoses were missed or delayed, with some patients subsequently seeing their cancer spread.

CDDFT Chief Executive Steve Russell has apologised “unreservedly” for the harm caused, describing what happened as “utterly unacceptable”.

The Trust is reviewing breast cancer cases from January 2023 to February 2025, alongside the cases of 640 former patients who contacted a dedicated helpline. It is also considering whether the review should be extended to examine up to 10,000 cases dating back as far as 2015.

A previous independent review of the Trust’s breast surgery service raised concerns about governance within the service, including how outsourced care was managed. The latest findings have now put renewed focus on the decisions made about patients’ treatment and the harm that can follow when those decisions go wrong.

Could this be medical negligence?

The findings raise an obvious question for patients affected: could unnecessary surgery or other failings in their treatment amount to medical negligence?

Potentially, yes. Medical negligence can arise where the care provided falls below an acceptable standard and, as a result, a patient suffers avoidable harm. Whether negligence occurred will depend on the circumstances of each individual case and the medical evidence.

In the cases being reviewed at CDDFT, reported concerns include women undergoing mastectomies that the Trust has since found were unnecessary, missed or delayed cancer diagnoses and questions around how treatment decisions were made.

Denise Howarth, for example, told the BBC that she initially underwent a lumpectomy before later having a mastectomy, chemotherapy and radiotherapy. She was subsequently informed by the Trust that she could have been offered a second lumpectomy rather than having her breast removed, but that option had not been discussed with her. Denise described being “in shock” when she received the news.

In breast cancer treatment, decisions about surgery can have permanent consequences. A mastectomy involves removing breast tissue and, where there are clinically appropriate alternatives, patients need clear information about their options so they can be involved in decisions about their care.

Current NICE guidance on early and locally advanced breast cancer covers breast-conserving surgery, further surgery and mastectomy, alongside the information and discussions that should support treatment decisions.

Depending on the circumstances, there may be grounds to investigate medical negligence where surgery was not clinically necessary, test results were misinterpreted, appropriate investigations were not carried out, treatment options were not properly considered or discussed, or another failure in care caused avoidable harm.

Not every poor outcome or complication amounts to negligence. However, where treatment was unnecessary or failures in care caused avoidable harm, it may be appropriate to investigate whether the standard of care was acceptable.

The impact on patients

Discovering that major surgery may have been unnecessary can have an enormous impact. A mastectomy can result in physical pain, permanent scarring and the need for further treatment or breast reconstruction. The effects can also extend far beyond the physical.

Patients may experience psychological distress, loss of confidence and concerns around body image, relationships and intimacy. Learning afterwards that surgery might have been avoided can add another layer of distress to an already difficult experience.

The BBC reported that some former patients are still living with the physical and psychological consequences of their treatment. It also highlighted concerns about how some treatment decisions were made. A Royal College of Surgeons review found that breast cancer cases had not always been properly discussed at multidisciplinary team meetings, where surgeons, radiologists, pathologists and cancer specialists can review and challenge proposed treatment plans before major decisions are made.

For patients affected, an apology or explanation may be important, but it cannot undo surgery. Where avoidable harm has occurred, patients may also need further medical treatment, reconstruction, counselling or other support over the longer term.

Do I have a claim?

If you have undergone treatment that you believe was unnecessary, inappropriate or delayed, this does not automatically mean that medical negligence occurred.

To bring a successful medical negligence claim, it will generally be necessary to show that the treatment you received fell below an acceptable standard of care and that this caused harm that would otherwise have been avoided.

Where negligence is established, compensation can reflect the individual impact of what happened. This may include pain and suffering, psychological injury and financial losses such as loss of earnings. It can also take account of the cost of additional surgery or treatment and any ongoing care, therapy or support that may be required.

For someone who has undergone an unnecessary mastectomy, this means looking at the whole effect of the treatment, not simply the surgery itself. The physical consequences, emotional impact, future treatment needs and effect on everyday life may all be relevant.

Patients concerned about treatment received through the CDDFT breast surgery service can also refer to the Trust’s information about its breast surgery service review and the support available to affected patients.

How we can help

If you are concerned that you have suffered avoidable harm because of medical treatment, our specialist Medical Negligence team can help.

We can listen to what happened and discuss your concerns before obtaining and reviewing your medical records. Where appropriate, we can investigate the treatment and advice you received, seek independent expert medical evidence and advise whether there may be grounds to bring a claim.

We can also consider the wider impact the treatment has had on your life, including any further treatment, psychological support, financial losses or future care needs that may need to form part of a claim.

We understand that questioning medical treatment can be difficult, particularly where you placed your trust in the professionals caring for you. If you believe you have suffered harm because of negligent medical treatment, contact our Medical Negligence team for confidential advice.