Breast cancer wait times: Use of breast screening clinics affect presenting stage

Abstract

10686 Background: Wait times in the navigation of the diagnostic and therapeutic system of breast cancer have been increasingly investigated. It is inherently apparent that an earlier diagnosis would lead to an improved prognosis in breast cancer. In Ontario (Canada) Breast Screening Clinics (OBSC) allow direct access of patients to mammograms. Methods: A retrospective review of all breast cancer patients seen in the regional cancer centre in the year 2003 was performed. Wait times between the following events were recorded: first symptom to presentation to medical system, presentation to mammogram, mammogram to biopsy, biopsy to surgery, surgery to consultation at cancer centre. Results: In 2003, 277 new cases of breast cancer were seen at the regional cancer centre. Identified median waiting times were as follows: mammogram to diagnostic biopsy - 18.5 days, diagnostic biopsy to definitive surgery - 28 days; surgical consultation to definitive surgery - 13 days; definitive surgery to oncology consultation - 31 days. Some wait times were longer in those patients who did not have close geographic access to OBSC and a regional cancer centre: mammography to diagnostic biopsy was doubled (17 to 34 days) and surgical consult to surgical date was doubled (12 vs 26.5 days). Eighty per cent (n = 27) of patients identified by OBSC presented with Stage I or less breast cancer vs 37% of all other patients. Seventeen per cent of patients seen at the regional cancer centre were less than 50 years of age and not eligible for the OBSC. Conclusions: The wait times reported are in keeping with the current experience in Ontario, Canada.[1] It is most likely that access to a breast-screening clinic allows self-selection of a more highly motivated population. This population of patients consistently presented with earlier stage and more curable disease. The challenge that remains is to increase the number of patients that access breast-screening clinics. Presently, only 13% of presenting patients seen at the regional cancer centre were identified by the OBSC. We are identifying barriers to the use of this very effective strategy. [1] Cancer Care Ontario. Ontario Wait Times Strategy. www.health.gov.on.ca. [Table: see text]