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Canadian Journal of Public Health

, Volume 91, Issue 2, pp 113–117 | Cite as

Waiting for a Diagnosis After an Abnormal Screening Mammogram

  • Ivo A. OlivottoEmail author
  • Lisa Kan
  • Sheila King
  • Peter Blair
  • Graham Clay
  • Eli Cox
  • Susan Harris
  • Maria Hugi
  • Lisa Kan
  • Sheila King
  • Heather MacNaughton
  • Carol Miller
  • Ivo Olivotto
  • Denise Pugash
  • Geoff Rowlands
  • John Todd
  • Judith Vestrup
Article

Abstract

Background: Women with abnormal screening mammograms require diagnostic assessment and experience anxiety until a diagnosis is established. This report evaluated the timeliness of diagnosis after an abnormal screening mammogram in the Screening Mammography Program of British Columbia (SMPBC).

Methods: Information on diagnostic interventions following an abnormal screen (N = 10,314) provided through 11 regional SMPBC services between January 1, 1993 and June 30, 1994 were abstracted and analyzed.

Results: The median time from abnormal screen to diagnosis was 3.4 weeks with regional variation of 2.0 to 4.7 weeks; 10% waited 8.7 weeks or longer. For the 19% of women proceeding to open biopsy, the median diagnostic interval was 7.1 weeks with regional variation of 4.6 to 9.3 weeks; 10% waited 13.1 weeks or longer.

Interpretation: After an abnormal screening mammogram, women waited many weeks for a definitive diagnosis, especially those proceeding to open biopsy. Opportunities for process improvement were identified.

Résumé

Contexte: Les femmes qui ont une mammographie anormale et qui nécessitent une évaluation diagnostique, vivent dans l’anxiété jusqu’à la confirmation du diagnostic. Ce rapport a cherché à évaluer les délais d’attente du diagnostic après une mammographie anormale dans le cadre du programme de dépistage par mammographie de la Colombie-Britannique (Screening Mammography Program of British Columbia ou SMPBC).

Méthodologie: Les données relatives aux interventions diagnostiques suite à une mammographie anormale (N = 10 314) provenant de 11 services régionaux faisant partie du Programme, et couvrant la période du 1er janvier 1993 au 30 juin 1994, ont été analysées.

Résultats: L’intervalle moyen entre la mammographie et la pose du diagnostic était de 3,4 semaines, avec des variations régionales de 2 à 4,7 semaines; 10 % des femmes ont dû attendre 8,7 semaines ou plus. Pour les 19 % sur lesquelles on a procédé à une biopsie, l’intervalle de temps avant le diagnostic était de 7,1 semaines, avec des variations régionales de 4,6 à 9,3 semaines; 10 % des femmes ont dû attendre 13,1 semaines ou plus.

Interprétation: Après une mammographie anormale, les femmes ont dû attendre de nombreuses semaines avant d’avoir un diagnostic définitif, notamment dans le cas de celles ayant eu une biopsie. Nous avons identifié un certain nombre de secteurs qui permettraient d’améliorer la procédure.

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References

  1. 1.
    Fletcher SW, Black W, Harris R, et al. Report of the International Workshop on Screening for Breast Cancer. J Natl Cancer Inst 1993;85:1644–56.CrossRefGoogle Scholar
  2. 2.
    Nystrom L, Rutqvist LE, Wall S, et al. Breast cancer screening with mammography: Overview of Swedish randomized trials. Lancet 1993;341:973–78 [published erratum appears in Lancet 1993;342:1372].CrossRefGoogle Scholar
  3. 3.
    Kerlikowske K, Grady D, Rubin SM, et al. Efficacy of screening mammography. A metaanalysis. JAMA 1995;273:149–54.CrossRefGoogle Scholar
  4. 4.
    Fentiman I. Pensive women, painful vigils: Consequences of delay in assessment of mammographic abnormalities. Lancet 1988;1:1041–42.CrossRefGoogle Scholar
  5. 5.
    Gram IT, Lund E, Slenker, SE. Quality of life following a false positive mammogram. Br J Cancer 1990;62:1018–22.CrossRefGoogle Scholar
  6. 6.
    Ong G, Austokar J. Breast screening: Adverse psychological consequences one month after placing women on early recall because of a diagnostic uncertainty: A multicentre study. J Med Screen 1997;4:158–68.CrossRefGoogle Scholar
  7. 7.
    Lerman C, Trock B, Rimer BK, et al. Psychological and behavioral implications of abnormal mammograms. Ann Intern Med 1991;114:657–61.CrossRefGoogle Scholar
  8. 8.
    Hislop TG, Worth AJ, Kan L, et al. Post screendetected breast cancer within the Screening Mammography Program of British Columbia. Breast Cancer Res Treat 1997;42:235–42.CrossRefGoogle Scholar
  9. 9.
    Murray-Sykes K. Organizing Assessment. National Health Service Breast Screening Programme. Breast Screen Publications, 1989.Google Scholar
  10. 10.
    Commonwealth Department of Human Services and Health (CDHSH). National Program for the Early Detection of Breast Cancer: National accreditation requirements. Australia: CDHSH, 1994.Google Scholar
  11. 11.
    Libstug A, Moravan V, Aitken, SE. Results from the Ontario Breast Screening Program, 1990–1995. J Med Screen 1998;5:73–80.CrossRefGoogle Scholar
  12. 12.
    Caines J, Chantziantoniou K, Wright BA, et al. Nova Scotia breast screening program experience: Use of needle-core biopsy in the diagnosis of screening-detected abnormalities. Radiology 1996;198:125–30.CrossRefGoogle Scholar
  13. 13.
    The Workshop Group. Reducing Deaths from Breast Cancer in Canada — Workshop report. CMAJ 1989;141:199–201.Google Scholar
  14. 14.
    Kerlikowske K. Timeliness of follow-up after abnormal screening mammography. Breast Cancer Res Treat 1996;40:53–64.CrossRefGoogle Scholar
  15. 15.
    Chang SW, Kerlikowske K, Napoles-Springer A, et al. Racial differences in timeliness of follow-up after abnormal screening mammography. Cancer 1996;78:1395–402.CrossRefGoogle Scholar
  16. 16.
    Baum M. Delayed assessment of mammographic abnormalities. Lancet 1988;1:1218.CrossRefGoogle Scholar
  17. 17.
    Burman ML, Taplin SH, Herta DF, et al. Effect of false-positive mammograms on interval breast cancer screening in a health maintenance organization. Ann Intern Med 1999;131:1–6.CrossRefGoogle Scholar
  18. 18.
    National Institutes of Health Consensus Development Panel. National Institutes of Health consensus development conference statement: Breast cancer screening for women ages 40–49, January 21–23, 1997. J Natl Cancer Inst 1997;89:1015–26.CrossRefGoogle Scholar
  19. 19.
    Kerlikowske K. Efficacy of screening mammography among women aged 40–49 years and 50–69 years: Comparison of relative and absolute benefit. Monogr Natl Cancer Inst 1997;22:79–86.CrossRefGoogle Scholar
  20. 20.
    Hendrick RE, Smith RA, Rutledge III JH, et al. Benefit of screening mammography in women aged 40–49: A new meta-analysis of randomized controlled trials. Monogr Natl Cancer Inst 1997;22:87–92.CrossRefGoogle Scholar
  21. 21.
    Bear, HD. Image-guided breast biopsy. How, when, and by whom? J Surg Oncol 1998;67:1–5.CrossRefGoogle Scholar
  22. 22.
    Britton PD, Flower CDR, Freeman AH, et al. Change to core biopsy in an NHS breast screening unit. Clin Radiol 1997;52:764–67.CrossRefGoogle Scholar
  23. 23.
    Litherland JC, Evans AJ, Wilson ARM, et al. The impact of core biopsy on pre-operative diagnosis rate of screen detected breast cancers. Clin Radiol 1996;51:562–65.CrossRefGoogle Scholar
  24. 24.
    Coates, AS. Breast cancer: Delays, dilemmas and delusions. Lancet 1999;353L:1112–13.CrossRefGoogle Scholar

Copyright information

© The Canadian Public Health Association 2000

Authors and Affiliations

  • Ivo A. Olivotto
    • 1
    • 2
    Email author
  • Lisa Kan
    • 1
  • Sheila King
    • 1
  • Peter Blair
  • Graham Clay
  • Eli Cox
  • Susan Harris
  • Maria Hugi
  • Lisa Kan
  • Sheila King
  • Heather MacNaughton
  • Carol Miller
  • Ivo Olivotto
  • Denise Pugash
  • Geoff Rowlands
  • John Todd
  • Judith Vestrup
  1. 1.The Screening Mammography Program of British Columbia (SMPBC) and the BC Cancer AgencyVancouverCanada
  2. 2.University of British ColumbiaVancouverCanada

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