Anxiety-filled wait for breast cancer diagnosis reduced to 1 day

Breast cancer patients in Toronto could receive same-day diagnosis and a treatment plan under an expanded pilot program announced on Thursday that drastically reduces anxiety-filled waits.

Breast cancer patients in Toronto could receive same-day diagnosis and treatment plans under an expanded pilot program announced on Thursday that drastically reduces anxiety-filled waits.

A $12.5-million donation from breast cancer survivor Emmanuelle Gattuso and her husband, broadcasting pioneer Allan Slaight, funded Princess Margaret Hospital's rapid tissue processor, which accurately reads biopsies in six to eight hours, as well as more pathologists and technicians.

"I think it's going to make an enormous difference, not only for women, but also their families, for their colleagues and their friends," said Gattuso, who recovered after her diagnosis in 2003. 

"They can organize. Once you know what you have to deal with, I think it's much easier to deal with it, and women have told us that over and over again."

Dr. David McCready, the Gattuso chair in breast surgical oncology and head of the breast site group at Princess Margaret, came up with the idea for the rapid diagnosis centre after he noticed patients referred to him waited about 37 days for a diagnosis.

"Get a mammogram, come back, get an ultrasound, go back, get the result, get a biopsy, another week or so later get the result, and then a referral," McCready said.

"All of these little steps can take not in itself a very long period of time, a few days, a week, but added up, that wait time can sometimes be very, very difficult."

The faster diagnosis does not have any impact on treatment or waiting times for chemotherapy or surgery, McCready said.

In the past three years, about 500 women have gone through the program, and the hospital hopes to accommodate 750 patients next year.

On Thursday, the hospital launched a new fundraising effort to raise a further $12.5 million to expand the centre to 3,000 patients by the last phase of the pilot project in 2013 to 2018.

The steps of rapid diagnosis are:

  • Patients arrive at the Rapid Diagnostic Breast Cancer Centre between 8 a.m. and 10 a.m.
  • Imaging and a core biopsy are done, with the tissue going into the rapid tissue processor.
  • Within hours, a pathologist analyzes the tissues and reports the results in the afternoon.
  • Surgical oncology team tells the patient whether the findings are benign or malignant.
  • If the tissue is malignant, a treatment plan is offered, such as surgery, radiation and chemotherapy.

Getting a treatment plan at Day 1 or Day 30 probably would not make a huge difference in a woman's outcome, so policy-makers likely wouldn't invest in it, said Mike Evans, a Toronto-based family physician.

"This is why this donation is so great," Evans said, adding it bypasses policy-makers to get the funding and offer a service that is "incredibly important" for anxious patients, and will likely cause other cancer programs across Canada to follow suit.

 

Wait time from abnormal screen to diagnosis of breast cancer (December 2007 unless otherwise indicated)  

In 1999, the Canadian Breast Cancer Screening Initiative adopted a target of seven weeks from abnormal screen to diagnosis if a biopsy is needed.

In 2002, P.E.I., N.S., Ontario and Alberta had a median time of less than seven weeks. By 2007, most provinces met the target.

Province/territoryWait time
AlbertaInformation not available
British ColumbiaWait time from abnormal screen to diagnosis of breast cancer is 2.9 weeks in Fast Track program, 4.1 weeks otherwise
ManitobaMedian wait times is 6.86 weeks in Manitoba Breast Screening Program
New Brunswick66.3% of women aged 50-59 met a five-week wait time target if no biopsy was required. 38.3% of women aged 50 to 69 met a seven-week wait time target if a biopsy is required
Newfoundland and LabradorInformation not available
Northwest TerritoriesAverage wait time to biopsy is 1.7 weeks. Average wait time to diagnosis is 3.3 weeks
Nova ScotiaMedian wait time for breast biopsy is less than 4.3 weeks
NunavutInformation not available
OntarioMedian wait time is 4.7 weeks for Ontario Breast Screening Program (2006 data)
Prince Edward IslandInformation not available
QuebecMedian wait time is 3.9 weeks (2004 data)
SaskatchewanMedian provincial wait time is 4.4 weeks
Yukon TerritoryWait time for diagnostic mammography is usually 2-3 days. Maximum wait time for diagnostic mammography is 1 week
Source: June 2008 report card from the Canadian Breast Cancer Network