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Comparison of wait times across the breast cancer treatment pathway among screened women undergoing organized breast assessment versus usual care

Abstract

Objective

The benefit of organized breast assessment on wait times to treatment among asymptomatic women is unknown. The Ontario Breast Screening Program (OBSP) offers screening and organized assessment through Breast Assessment Centres (BAC). This study compares wait times across the treatment pathway among screened women diagnosed with breast cancer through BAC and usual care (UC).

Methods

A retrospective design identified two concurrent cohorts of postmenopausal women aged 50–69 within the OBSP diagnosed with screen-detected invasive breast cancer and assessed in BAC (n = 2010) and UC (n = 1844) between 2002 and 2010. Demographic characteristics were obtained from the OBSP. Medical chart abstraction provided prognostic and treatment data. Multinomial logistic regression examined associations of assessment type with wait times from abnormal mammogram to surgery, chemotherapy or radiotherapy.

Results

Compared with through UC, postmenopausal women diagnosed through BAC were significantly less likely to have longer wait times (days) from an abnormal mammogram to definitive surgery (> 89 vs. ≤ 47; OR = 0.63; 95% CI = 0.52–0.77), from final surgery to radiotherapy (> 88 vs. ≤ 55; OR = 0.71; 95% CI = 0.54–0.93) and from final chemotherapy to radiotherapy (> 41 vs. ≤ 28; OR = 0.52; 95% CI = 0.36–0.76). Conversely, women assessed through BAC compared with through UC were more likely to experience longer wait times from final surgery to chemotherapy (> 64 vs. ≤ 40; OR = 1.49; 95% CI = 1.04–2.14).

Conclusion

Shorter wait times to most treatments for postmenopausal women diagnosed in BAC further supports that women with an abnormal mammogram should be managed through organized assessment. Continued evaluation of factors influencing wait times to treatment is essential for quality improvement and patient outcomes.

Résumé

Objectif

On ignore si l’évaluation organisée de la santé du sein réduit les délais d’attente de traitement des femmes asymptomatiques. Le Programme ontarien de dépistage du cancer du sein (PODCS) offre le dépistage et l’évaluation organisée dans des centres d’évaluation de la santé du sein (CÉSS). Notre étude compare les délais d’attente selon la voie de traitement pour les femmes ayant subi un dépistage et reçu un diagnostic de cancer du sein dans des CÉSS ou par les soins habituels (SH).

Méthode

Un protocole rétrospectif a permis de définir au sein du PODCS deux cohortes parallèles de femmes postménopausées âgées de 50 à 69 ans atteintes d’un cancer invasif du sein détecté par dépistage et évaluées dans des CÉSS (n = 2 010) et par les SH (n = 1 844) entre 2002 et 2010. Leurs caractéristiques démographiques ont été extraites du PODCS. Un résumé analytique des dossiers médicaux a fourni les données de pronostic et de traitement. Par régression logistique multinomiale, nous avons examiné les associations entre le type d’évaluation et les délais d’attente entre une mammographie anormale et la chirurgie, la chimiothérapie ou la radiothérapie.

Résultats

Comparativement à celles ayant reçu un diagnostic par les soins habituels, les femmes postménopausées ayant reçu un diagnostic dans un centre d’évaluation de la santé du sein étaient significativement moins susceptibles d’avoir enduré des délais d’attente plus longs (en jours) entre une mammographie anormale et la chirurgie définitive (> 89 c. ≤ 47; RC = 0,63; IC de 95 % = 0,52-0,77), entre la dernière chirurgie et la radiothérapie (> 88 c. ≤ 55; RC = 0,71; IC de 95 % = 0,54-0,93) et entre la dernière chimiothérapie et la radiothérapie (> 41 c. ≤ 28; RC = 0,52; IC de 95 % = 0,36-0,76). À l’inverse, les femmes évaluées dans les CÉSS étaient plus susceptibles que celles évaluées par les soins habituels d’avoir enduré des délais d’attente plus longs entre la dernière chirurgie et la chimiothérapie (> 64 c. ≤ 40; RC = 1,49; IC de 95 % = 1,04-2,14).

Conclusion

Les délais d’attente plus courts avant la plupart des traitements chez les femmes postménopausées ayant reçu un diagnostic dans un centre d’évaluation de la santé du sein constituent une preuve supplémentaire que les femmes ayant subi une mammographie anormale devraient être prises en charge par un programme d’évaluation organisé. Il est essentiel de poursuivre l’analyse des facteurs qui influent sur les délais d’attente de traitement pour améliorer la qualité des soins et l’issue pour les patientes.

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Acknowledgements

We thank the study staff, Brittany Speller, Leanne Lindsay, Lucy Leon and Anjali Pandya. We also thank Jessie Cunningham for assisting in the literature search. We acknowledge Cancer Care Ontario for use of its data.

Funding

This work was supported by the Canadian Institutes of Health Research (grant number 130400). This agency had no involvement in the study design, data collection, analysis, interpretation, manuscript preparation or the decision to submit the manuscript for publication.

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Correspondence to Anna M. Chiarelli.

Ethics declarations

We can confirm that we have observed appropriate ethical guidelines and legislation in conducting the study. The study was approved by the University of Toronto Research Ethics Board (Protocol #29342), and informed consent was not required as there was no direct contact with women and the study falls within the ethical domain of non-consensual research. In addition, Research Ethics Board approval was obtained for each regional cancer centre for medical chart abstraction.

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The authors declare that they have no conflict of interest.

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Blackmore, K.M., Weerasinghe, A., Holloway, C.M.B. et al. Comparison of wait times across the breast cancer treatment pathway among screened women undergoing organized breast assessment versus usual care. Can J Public Health 110, 595–605 (2019). https://doi.org/10.17269/s41997-019-00210-7

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  • DOI: https://doi.org/10.17269/s41997-019-00210-7

Keywords

  • Breast cancer
  • Organized breast assessment
  • Treatment wait times
  • Surgery
  • Chemotherapy
  • Radiotherapy

Mots-clés

  • Cancer du sein
  • Évaluation organisée de la santé du sein
  • Délais d’attente de traitement
  • Chirurgie
  • Chimiothérapie
  • Radiothérapie