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Effect of Screening Result on Waiting Times to Assessment and Breast Cancer Diagnosis

Results from the Ontario Breast Screening Program

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Canadian Journal of Public Health Aims and scope Submit manuscript

Abstract

Background

The effect of severity of screening result on delays to diagnosis has primarily been examined for mammographic abnormalities. This study will examine delays to assessment and diagnosis for women with an abnormal mammogram compared to women with an abnormal clinical breast examination (CBE) or abnormal CBE and mammogram.

Methods

Using data routinely collected by Ontario Breast Screening Program (OBSP), 12,675 women aged 50 to 69 with an abnormal screening result between January 1, 2000 and December 31, 2000 were followed prospectively to the completion of their assessment process. Median waiting times from abnormal screen to first assessment procedure and diagnosis were compared by modality of referral and among women with a breast cancer diagnosis by prognostic features.

Results

The median waiting time to first assessment and to diagnosis was significantly longer for women with only a clinical abnormality compared to women with a mammographic abnormality. In addition, women diagnosed with cancers of larger size had longer delays when the abnormality was detected only clinically. However, women referred by both modalities had significantly shorter waiting times to first assessment procedure and to diagnosis of poor prognosis cancers compared to women referred by mammography alone.

Interpretation

Women with an abnormal CBE and mammogram are assessed more promptly and have shorter diagnostic times. However, women with only a CBE abnormality had delays to diagnosis as a result of longer waiting times to first assessment procedure. Integration of the OBSP with assessment centres should improve times to diagnosis irrespective of modality of referral.

Résumé

Contexte

Le rapport entre la gravité du résultat d’un test de dépistage et le délai d’obtention d’un diagnostic a surtout été étudié pour les mammographies anormales. Nous avons étudié les délais d’évaluation et de diagnostic des femmes ayant eu des résultats anormaux à une mammographie, et nous les avons comparés aux délais des femmes ayant eu des résultats anormaux à un examen clinique des seins (ECS), ou à un ECS combiné à une mammographie.

Méthode

à l’aide des données recueillies systématiquement par le Programme ontarien de dépistage du cancer du sein, nous avons suivi rétrospectivement 12 675 femmes âgées de 50 à 69 ans ayant obtenu des résultats anormaux entre le 1er janvier et le 31 décembre 2000 jusqu’à l’aboutissement de leur processus d’évaluation. Nous avons comparé les délais d’attente médians entre le test de dépistage et la première évaluation et le diagnostic, d’abord selon le mode d’acheminement des patientes, puis, pour les femmes ayant reçu un diagnostic de cancer du sein, selon leur pronostic.

Résultats

Le délai d’attente médian avant la première évaluation et le diagnostic était sensiblement plus long pour les femmes ayant eu un ECS anormal que pour celles ayant eu une mammographie anormale. De plus, les femmes chez qui on avait diagnostiqué des cancers avancés attendaient plus longtemps lorsque l’anomalie avait été décelée par ECS seulement. Toutefois, les femmes dirigées après un ECS combiné à une mammographie attendaient sensiblement moins longtemps avant la première évaluation, et donc avant le diagnostic de cancer avancé, que les femmes dirigées après une mammographie seulement.

Interprétation

Les femmes dont l’ECS et la mammographie sont tous les deux anormaux sont évaluées plus rapidement, et elles attendent moins longtemps leur diagnostic. Pour les femmes n’ayant qu’un ECS anormal, le délai de diagnostic est plus long, du fait qu’elles attendent plus longtemps avant leur première évaluation. En intégrant le Programme ontarien de dépistage du cancer du sein dans les centres d’évaluation, on devrait pouvoir améliorer les délais de diagnostic, quel que soit le mode d’acheminement des patientes.

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Authors and Affiliations

  1. Division of Preventive Oncology, Cancer Care Ontario, 620 University Avenue, Toronto, ON, M5G 2L7, Canada

    Anna M. Chiarelli PhD (Scientist), Verna Mai MD, MHSc, FRCPC, Erika E. Halapy MSc, Rene S. Shumak MD, FRCPC & Neil S. Klar PhD

  2. Department of Public Health Sciences, University of Toronto, Canada

    Anna M. Chiarelli PhD (Scientist), Verna Mai MD, MHSc, FRCPC & Neil S. Klar PhD

  3. Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, ON, Canada

    Frances P. O’Malley MB, FRCPC

Authors
  1. Anna M. Chiarelli PhD
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  2. Verna Mai MD, MHSc, FRCPC
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  3. Erika E. Halapy MSc
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  4. Rene S. Shumak MD, FRCPC
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  5. Frances P. O’Malley MB, FRCPC
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  6. Neil S. Klar PhD
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Correspondence to Anna M. Chiarelli PhD.

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Chiarelli, A.M., Mai, V., Halapy, E.E. et al. Effect of Screening Result on Waiting Times to Assessment and Breast Cancer Diagnosis. Can J Public Health 96, 259–263 (2005). https://doi.org/10.1007/BF03405159

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  • DOI: https://doi.org/10.1007/BF03405159

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