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Waiting times from abnormal breast screen to diagnosis in 7 Canadian provinces

Ivo A. Olivotto^*, Christina Bancej, Vivek Goel^¶, Judy Snider, Ronald G. McAuley^**, Brenda Irvine, Lisa Kan^*, Doug Mirsky, Margaret J. Sabine, Renée McGilly^¶¶ and Judy S. Caines^***

From *the Screening Mammography Program of British Columbia and the Division of Radiation Oncology, University of British Columbia, Vancouver, BC; Health Canada, Ottawa, Ont.; the Department of Epidemiology and Biostatistics, McGill University, Montreal, Que., ¶the Department of Preventive Medicine and Biostatistics, University of Toronto, Toronto, Ont., the Departments of **Family Practice and Radiology, McMaster University, Hamilton, Ont.; the Ontario Breast Screening Program, the Department of Surgery, University of Ottawa, Ottawa, Ont.; ¶¶the Canadian Breast Cancer Network, Victoria, BC; and ***the Nova Scotia Breast Screening Program and the Department of Radiology, Dalhousie University, Halifax, NS

Correspondence to: Dr. Ivo A. Olivotto, BC Cancer Agency – Vancouver Island, 2410 Lee Ave., Victoria BC V8R 6V5

Background: Delay to breast cancer diagnosis following an abnormal screening result is associated with anxiety and personal disruption. We assessed the patterns and timeliness of diagnostic follow-up after breast cancer screening for women with abnormal results who attended organized screening programs in 7 provinces.

Methods: Using data from the Canadian Breast Cancer Screening Database, we identified 203 141 women aged 50–69 years who underwent screening in 1996 through provincially organized breast cancer screening programs in British Columbia, Alberta, Saskatchewan, Manitoba, Ontario, Nova Scotia and Newfoundland. We prospectively followed women with an abnormal screening result through to the completion of the assessment process. We evaluated the waiting times from screening examination to first assessment, from screening examination to first imaging, from screening examination to diagnosis and from first assessment to diagnosis for 13 958 women, stratified according to screening program, mode of detection, whether a biopsy was performed and whether cancer was diagnosed.

Results: We observed considerable variations between and within programs in the time to diagnosis. The median time from screening examination to first assessment was 2.6 weeks. The median time from screening examination to diagnosis was 3.7 weeks; this time increased to 6.9 weeks for women undergoing biopsy. Even when no biopsy was performed, 10% of the women waited 9.6 weeks or longer for a diagnosis, as compared with 15.0 weeks or longer for 10% of the women undergoing biopsy. Among the women who had a biopsy, the use of core biopsy was associated with a shorter median time to diagnosis than was open biopsy, and those found to have cancer had shorter waiting times than women with benign biopsy findings.

Interpretation: Women undergoing assessment of an abnormal breast cancer screening result waited many weeks for a diagnosis, especially when a biopsy was performed. To ensure that targets for timeliness, adopted nationally in 1999, are realized, improved models of care or dissemination of existing efficient techniques to reach a diagnosis will be needed.

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