When Elena Ivanova found a lump in her right breast after a skiing accident in early 2016, she wasn’t too worried. Years ago, after breastfeeding her two daughters, she noticed a similar lump but it turned out to be nothing.
Ivanova wanted to make sure of this, so she went to see her family doctor. A mammogram and biopsy followed, before a shocking appointment with a surgeon who told Ivanova she had a rare and aggressive cancer known as metaplastic carcinoma.
“I couldn’t believe it. Time has stopped for me,” said the 61-year-old dog groomer from North Vancouver, British Columbia.
Just nine days later, on March 24, 2016, Ivanova underwent a total mastectomy, preparing for the chemotherapy and radiotherapy that would follow.
But when it came to her first appointment with her BC Cancer oncologist to discuss a treatment plan, Evanova 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. Why did you have this surgery? … I know it’s good news, but it was very, very difficult, because it’s a human body. If you damage it, you can’t get it back.”
In May, more than seven years after Ivanova’s double mastectomy, a civil jury of the British Columbia Supreme Court awarded her $400,000 in damages from Dr. Robert Wolper, the pathologist who misdiagnosed her with cancer.
But Wolper is appealing that ruling, which means the bulk of the jury award has been deferred, and it will be months before Ivanova gets a resolution.
The wait was frustrating.
“I really wanted to find the truth,” said Ivanova. “People must be protected. Mistakes like this should not be made, and if they are made, they must be fixed.”
Biopsy report ‘unclear and inconsistent’
Wolber did not respond to requests for comment. His response to Ivanova’s allegation denied any negligence and asserted that “all medical procedures and investigations conducted by him with respect to the plaintiff were appropriate to the circumstances and in accordance with standard medical practice”.
The response notes that while Wolper’s biopsy report diagnosed Ivanova with metatarsal carcinoma, his recommendation was an excisional biopsy to remove the mass so it could be examined more closely, not a mastectomy.
But Dr. Ashley Cimino-Matthews, a pathologist at Johns Hopkins University in the US who specializes in breast tumors, wrote in an expert witness report that an excisional biopsy would not be the appropriate response for such an aggressive cancer.
Her report says Wollber’s decision to diagnose metaplastic breast cancer “unequivocally” fell “below standard of care,” and he should have reported uncertainty about the diagnosis in his biopsy report.
In finding Wolper negligent, the jury called Wolper’s pathological report “confusing” in light of the seriousness of the diagnosis.
“He diagnosed one disease and recommended treatment for another. This was unclear, contradictory, and below the standard of care of a reasonably wise pathologist,” the jury wrote.
Wolper exercises the same right of appeal that every Canadian has, said Ivanova’s attorney, Don Reno, but the appeals court action will only add to the cost of an already expensive legal battle.
He argues that it is only possible for doctors to shell out so much money to defend themselves from allegations of negligence thanks to the deep pockets of the Canadian Medical Protection Association (CMPA).
CMPA is a joint defense organization that defends physicians accused of wrongdoing using assets valued at more than $6 billion. It is funded by annual fees paid by physicians, the greater part of which is paid out of public funds through agreements with provinces and territories.
“What really should have happened here is that, with the proper public understanding of what happened, those practices that led to this tragedy could be improved,” Renault said.
A CMPA spokesperson told CBC that the organization is unable to comment on individual doctors, and it would be inappropriate to say anything about a matter still before the courts.
I got rid of all my pretty clothes.
Ivanova says the mastectomy has permanently damaged her physical and mental health.
“I was always in good physical shape, but after the surgery I started having nightmares. I couldn’t sleep properly,” she said.
“I no longer feel like an attractive woman. I have to hide my damage. I have thrown off all my pretty clothes.”
She says she loves hiking, but constant weakness means she can no longer manage the same intensity on her mountain treks. Yoga leaves her with back pain she never had before.
“It’s hard to accept,” she said of her new reality.
Ivanova’s lawsuit also accused the surgeon who performed the surgery of negligence, but the jury found that she did not violate standards of care.
watch | Elena Ivanova discusses the impact of the diagnosis on her life:
Today, Evanova believes that anyone who finds themselves with a scary diagnosis and strict treatment recommendations should not be afraid to advocate for more information from their doctors.
“They’re good and highly educated,” she said, “but they have to give you more time, more attention. If you get one opinion, get a second opinion, a third opinion.”
“Ask them to explain 10,000 times. Their job is to explain to you properly. We are not doctors.”