Key message
Three of nine provinces achieved the five-week wait time target for women not requiring a biopsy for resolution. None of the provinces achieved the seven-week target set for women who require a biopsy for resolution.
Indicator definition
The median and 90th percentile wait times between an abnormal breast screen result and resolution, with or without biopsy, for asymptomatic women aged 50–69 screened by provincial breast screening programs in 2013. Results are reported by province and year.
Target
90% of women should achieve resolution of an abnormal breast screen within five weeks for those not requiring a biopsy and within seven weeks for those requiring a biopsy, established by the Canadian Breast Cancer Screening Network.1
Measured since
The 2009 Cancer System Performance Report.
Why measure this?
Timely resolution (positive or negative) of an abnormal breast screen result through clinical investigation and a definitive biopsy (if required) can reduce unnecessary stress and anxiety for patients and their families (e.g., by reducing the time women wait for results of a breast biopsy) and may even improve patient outcomes (e.g., by promptly initiating treatment for women with a positive diagnosis of breast cancer).2 Understanding variations in breast cancer diagnosis wait times across Canada can help to reveal where efforts need to be targeted to improve how various parts of the system involved in screening and diagnosing breast cancer work together to ensure prompt resolution of abnormal results.
What are the key findings?
- In 2013, 90th percentile wait times for resolution of an abnormal breast screen for women not requiring a tissue biopsy ranged from 4.0 weeks in Alberta to 8.0 weeks in both British Columbia and Newfoundland and Labrador (nine provinces submitted data) (Figure 3.1). Three provinces—Alberta, Manitoba and Ontario—achieved the five-week target. In 2012, Alberta, Ontario and New Brunswick achieved the five-week target (data not shown).
- The 90th percentile wait times for resolution of an abnormal breast screen for women who required a tissue biopsy ranged from 10.6 weeks in Prince Edward Island to 15.0 weeks in Newfoundland and Labrador (Figure 3.2). None of the eight reporting provinces achieved the seven-week target.
Why do these findings matter?
Women with abnormal breast screens continue to wait many weeks for a diagnosis (cancer or benign), especially when a tissue biopsy is required for diagnosis. Waiting for a diagnosis can be a stressful time for patients and their families. Even though diagnostic intervals of a few weeks are unlikely to affect patient outcomes (e.g., survival), efforts to reduce wait times can have positive implications for patient experience (e.g., reduced stress and anxiety).3 Breast cancer diagnosis wait times may be affected by
- System-level factors (e.g., lack of access to primary care, variable access to and process for surgical referrals, variable navigation services for patients, lack of centralized triage and booking, and limited integration among health care providers involved in screening and diagnosis, among others)
- Physician-driven factors (e.g., physicians may expedite investigations for women with a high suspicion of cancer)3
- Patient-driven factors (e.g., women may postpone follow-up until it is convenient for them)
The many parts of the system involved in screening and diagnosing breast cancer need to work together at multiple levels to address these factors and to drive for efficient processes and reduced wait times.
References
- Health Canada. Waiting for a Diagnosis After an Abnormal Breast Screen in Canada. Ottawa (ON): 2000.
- Lang EV, Berbaum KS, Lutgendorf SK. Large-core breast biopsy: abnormal salivary cortisol profiles associated with uncertainty of diagnosis. Radiology. 2009 Mar;250(3):631-7.
- Olivotto IA, Bancej C, Goel V, Snider J, McAuley RG, Irvine B, et al. Waiting times from abnormal breast screen to diagnosis in 7 Canadian provinces. CMAJ. 2001;165(3):277-83.
