When Elena Ivanova found a lump in her right breast after a skiing accident in early 2016, she wasn’t too concerned. Years previously, after breast-feeding her two daughters, she’d noticed a similar mass but it turned out to be nothing.
Ivanova wanted to be sure, though, so she went to see her family doctor. A mammogram and a biopsy followed, before a shocking appointment with a surgeon who told Ivanova she had a rare, aggressive cancer known as a metaplastic carcinoma.
“I couldn’t believe it. Time stopped for me,” the 61-year-old dog groomer from North Vancouver, B.C., said.
Just nine days later, on March 24, 2016, Ivanova underwent a total mastectomy, and braced herself for the punishing chemotherapy and radiation treatments that would follow.
But when it came time for her first appointment with an oncologist at B.C. Cancer to discuss a treatment plan, Ivanova was hit with another bombshell.
“The doctor said, ‘I have good news. You don’t have cancer,'” she recalled in an interview with CBC News.
“It’s hard to describe what I felt. For what I had this surgery? … I know it’s good news, but it was very, very, very hard, because it’s a human body. If you damage it, you can’t restore it.”
In May, more than seven years after Ivanova had her breast removed, a B.C. Supreme Court civil jury awarded her $400,000 in damages from Dr. Robert Wolber, the pathologist who wrongly diagnosed her with cancer.
But Wolber is appealing that verdict, which means the bulk of the jury’s award has been held back, and it will be months before Ivanova has a resolution.
The wait has been frustrating.
“I really wanted to find the truth,” Ivanova said. “People have to be protected. Mistakes like this shouldn’t be done, and if they are done, it needs to be fixed.”
‘Unclear, contradictory’ biopsy report
Wolber has not responded to requests for comment. His response to Ivanova’s claim denied any negligence and maintained that “all medical procedures and investigations carried out by him with respect to the plaintiff were appropriate to the circumstances and in accord with standard medical practice.”
The response points out that while Wolber’s biopsy report did diagnose Ivanova with metaplastic carcinoma, his recommendation was for an excisional biopsy to remove the lump so it could be examined more closely, and not a mastectomy.
But Dr. Ashley Cimino-Mathews, a pathologist at Johns Hopkins University in the U.S. who specializes in breast tumours, wrote in an expert witness report that an excisional biopsy would not be the appropriate response to such an aggressive cancer.
Her report says Wolber’s decision to “unequivocally” diagnose metaplastic breast carcinoma fell “below the standard of care,” and he should have communicated any uncertainty about the diagnosis in his biopsy report.
In finding Wolber negligent, the jury described Wolber’s pathology report as “confusing” in light of the seriousness of the diagnosis.
“He diagnosed one illness and recommended treatment for another. This was unclear, contradictory and below the standard of care for a reasonably prudent pathologist,” the jury wrote.
Ivanova’s lawyer, Don Renaud, said Wolber is exercising the same right to appeal that every Canadian enjoys, but the appeal court process will only add to the cost of an already very expensive legal fight.
He argues it’s only possible for doctors to pour so much money into defending themselves from negligence allegations thanks to the deep pockets of the Canadian Medical Protective Association (CMPA).
The CMPA is a mutual defence organization that defends doctors accused of wrongdoing using assets valued at more than $6 billion. It’s funded through annual fees paid by doctors, the bulk of which is reimbursed with public money through agreements with the provinces and territories.
“What really should have happened here is that, with appropriate public understanding of what took place, then those practices that led to this tragedy can be improved,” Renaud said.
A CMPA spokesperson told CBC the organization was unable to comment on individual doctors, and it would be inappropriate to say anything about a matter that is still before the courts.
‘I threw away all my beautiful dresses’
Ivanova says the mastectomy has done lasting damage to her physical and mental health.
“I was always in good physical condition, but after the surgery I started to have nightmares. I couldn’t sleep properly,” she said.
“I don’t feel like I’m an attractive woman anymore. I have to hide my damage. I threw away all my beautiful dresses.”
She says she loves to hike, but ongoing weakness means she can no longer manage the same intensity on her mountain treks. Yoga leaves her with back pain she’s never had before.
“It’s hard to accept,” she said of her new reality.
Ivanova’s lawsuit also accused the surgeon who performed her surgery of negligence, but the jury found she did not breach the standard of care.
Today, Ivanova believes anyone who finds themselves with a scary diagnosis and drastic treatment recommendations shouldn’t be afraid to advocate for more information from their doctors.
“They are good, they’re highly educated, but they have to give you more time, more attention. If you get one opinion, get a second opinion, third opinion,” she said.
“Ask them to explain 10,000 times. It’s their job to explain to you properly. We are not doctors.”