Women are still waiting too long for their first breast surgery after an abnormal mammogram, even though the median wait time between these two events decreased between 2002 and 2006. Meanwhile, those who had an abnormal mammogram but did not have cancer are learning about the good news more quickly.
Indicators by LHIN
||As of this report
|Wait times for surgical excision of breast cancer after an abnormal mammogram
|Wait times for benign resolution after an abnormal mammogram
What's new this year?
This report presents new 2006 data.
Figure 1: Median waits (in weeks) from abnormal screen to first surgical excision for breast cancer patients, 2002, 2004, 2006 | download in CSV or Excel format
Figure 2: Median waits (in weeks) from abnormal screen to resolution for women without breast cancer, 2002, 2004, 2006 | download in CSV or Excel format
What do the results show?
Slight improvement in wait times for women with breast cancer
For women with breast cancer, the wait times after an abnormal mammogram to their first surgery decreased by a week between 2002 and 2006, from 21 to 20 weeks, as shown in Figure 1.
Progress in wait times for women with benign diagnosis
As shown in Figure 2, for women who had an abnormal mammogram that did not result in a cancer diagnosis, median wait times decreased by 50% – from 14 weeks to seven weeks – between 2002 and 2006.
Results vary across regional cancer centres
Both measures showed substantial variations across regions. For instance, in 2006 the median wait time between an abnormal mammogram and breast cancer surgery ranged from 13 to 31 weeks, as shown in Figure 1. Similarly, the wait time between abnormal mammogram and benign resolution was four weeks in the best performing region and 19 weeks in the poorest performing region, as shown in Figure 2.
Why is this important to patient care?
Long waits for diagnosis cause distress in patients
Delay in assessing any abnormal mammogram increases patient anxiety, with psychological distress intensifying as the waiting time for diagnosis gets longer. 1
Delay between mammogram and diagnosis can lead to poor outcomes
Canadian Medical Association practice guidelines for breast cancer emphasize that diagnostic tests should be completed as soon as possible after a lump in the breast is detected. 2 Research suggests that a long delay between an abnormal mammogram and a diagnosis of breast cancer can lead to adverse outcomes. 3
How does Ontario compare?
Similar wait times in Nova Scotia and Saskatchewan
Nova Scotia reports wait times similar to Ontario’s, with a recent study revealing a median wait of 91 days, or 13 weeks, between abnormal screen and first treatment for breast cancer. 4
In Saskatchewan, the wait between suspicion of breast cancer and final mode of treatment, either by surgery or adjuvant therapy, is 17 weeks. It should be noted, however, that this period includes the first surgical excision, which occurs approximately nine weeks earlier. 5
Shorter waits in the United Kingdom
In the United Kingdom, the median wait time from general practitioner referral to first breast cancer treatment is 27 days for urgent referrals and 35 days for less urgent referrals. 6
This four to five week wait is shorter than Ontario wait times.
What is being done?
Streamlining diagnostic assessment for breast cancer
Several Regional Cancer Programs, including those based in Hamilton and Ottawa, are streamlining diagnostic assessment for breast cancer and other types of cancer.
Setting wait times for diagnostic assessment in the Ontario Cancer Plan
Building on this effort, the Ontario Cancer Plan 2008-2011 sets out a plan to establish wait time targets for diagnostic assessment and more regular measurements of waiting times. The Ontario Cancer Plan also asks for funding to set up rapid diagnostic assessment units, where a skilled investigative team can provide fast diagnosis or immediate discharge of women with benign results.
1 Risberg T, Sorbye SW, Norum J, Wist EA. Diagnostic delay causes more psychological distress in female than in male cancer patients. Anticancer Research 1996; 16(2):995-999.
2 Steering Committee on Clinical Practice Guidelines for the Care and Treatment of Breast Cancer. Clinical practice guidelines for the care and treatment of breast cancer: 1. The palpable breast lump: information and recommendations to assist decision-making when a breast lump is detected. CMAJ 1998;158(3 Suppl):S3-8. Available at http://www.cmaj.ca/cgi/content/full/158/3/DC1. Accessed April 18, 2008.
3 Olivotto IA, Gomi A, Bancej C, Brisson J, Tonita J, Kan L, Mah Z, Harrison M, Shumak R. Influence of delay to diagnosis on prognostic indicators of screen-detected breast carcinoma. Cancer 2002;15:95:2254-5.
4 Rayson D, Chiasson D, Dewar R. Elapsed time from breast cancer detection to first adjuvant therapy in a Canadian province, 1999-2000. CMAJ 2004; 170:957-61.
5 Rathgeber M, Chan BT, MacDermott WE, Willoughby KA, Cascagnette P. The time it takes: Breast cancer care in Saskatchewan. Saskatoon: Health Quality Council; 2006. Available at http://www.hqc.sk.ca/download.jsp?P5CsKqB/ni2+FmD5hljG+TBIzBf0QfLQkUwK4QBZaJusgghMEl1YSg==. Accessed April 18, 2008.
6 Spurgeon P, Barwell F, Kerr D. Waiting times for cancer patients in England after general practitioners' referrals: retrospective national survey. BMJ 2000; 320:838-9.