Skip to main content

Advertisement

SpringerLink
Log in

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

  • Quantitative Research
  • Published:
Canadian Journal of Public Health Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  • American Joint Committee on Cancer. (2002). Cancer staging manual (6th ed.). New York: Springer-Verlag.

    Google Scholar 

  • Balduzzi, A., Leonardi, M. C., Cardillo, A., Orecchia, R., Dellapasqua, S., Iorfida, M., et al. (2010). Timing of adjuvant systemic therapy and radiotherapy after breast-conserving surgery and mastectomy. Cancer Treatment Reviews, 36(6), 443–450 Epub 2010 Mar 20.

    Article  Google Scholar 

  • Benk, V., Przybysz, R., McGowan, T., & Paszat, L. (2006). Waiting times for radiation therapy in Ontario. Canadian Journal of Surgery, 49(1), 16–21.

    PubMed Central  Google Scholar 

  • Canadian Cancer Society’s Steering Committee. Canadian Cancer Statistics. (2011). Toronto (p. 2011). ON: Canadian Cancer Society.

    Google Scholar 

  • Cancer Care Ontario. (2010).Wait Times. from: http://www.cancercare.on.ca/cms/One.aspx?portalId=1377&pageId=8836. Accessed 04/29/2013, 2013.

  • Cancer Care Ontario. (2016). Ontario Cancer Screening Performance Report 2016. Toronto.

  • Caplan, L. S., May, D. S., & Richardson, L. C. (2000). Time to diagnosis and treatment of breast cancer: Results from the National Breast and Cervical Cancer Early Detection Program, 1991-1995. American Journal of Public Health, 90(1), 130–134.

    Article  CAS  Google Scholar 

  • Chen, Z., King, W., Pearcey, R., Kerba, M., & Mackillop, W. J. (2008). The relationship between waiting time for radiotherapy and clinical outcomes: a systematic review of the literature. Radiotherapy and Oncology, 87(1), 3–16 Epub 2007 Dec 21.

    Article  Google Scholar 

  • Chiarelli, A. M., Edwards, S. A., Prummel, M. V., Muradali, D., Majpruz, V., Done, S. J., et al. (2013). Digital compared with screen-film mammography: performance measures in concurrent cohorts within an organized breast screening program. Radiology., 268(3), 684–693.

    Article  Google Scholar 

  • Chiarelli, A. M., Muradali, D., Blackmore, K. M., Smith, C. R., Mirea, L., Majpruz, V., et al. (2017). Evaluating wait times from screening to breast cancer diagnosis among women undergoing organised assessment vs usual care. British Journal of Cancer, 116(10), 1254.

  • Hammond, M. E., Hayes, D. F., Dowsett, M., Allred, D. C., Hagerty, K. L., Badve, S., et al. (2010). American Society of Clinical Oncology/College of American Pathologists guideline recommendations for immunohistochemical testing of estrogen and progesterone receptors in breast cancer (unabridged version). Archives of Pathology & Laboratory Medicine, 134(7), e48–e72.

    CAS  Google Scholar 

  • Haynes, W. (2013). Wilcoxon rank sum test. In Encyclopedia of Systems Biology (pp. 2354–2355). Berlin: Springer.

    Chapter  Google Scholar 

  • Huang, J., Barbera, L., Brouwers, M., Browman, G., & Mackillop, W. J. (2003). Does delay in starting treatment affect the outcomes of radiotherapy? A systematic review. Journal of Clinical Oncology, 21(3), 555–563.

    Article  Google Scholar 

  • Jaro, M. A. (1995). Probabilistic linkage of large public health data files. Statistics in Medicine, 14(5–7), 491–498.

    Article  CAS  Google Scholar 

  • Lohrisch, C., Paltiel, C., Gelmon, K., Speers, C., Taylor, S., Barnett, J., et al. (2006). Impact on survival of time from definitive surgery to initiation of adjuvant chemotherapy for early-stage breast cancer. Journal of Clinical Oncology, 24(30), 4888–4894 Epub 2006 Oct 2.

    Article  Google Scholar 

  • Olivotto, I. A., Lesperance, M. L., Truong, P. T., Nichol, A., Berrang, T., Tyldesley, S., et al. (2009). Intervals longer than 20 weeks from breast-conserving surgery to radiation therapy are associated with inferior outcome for women with early-stage breast cancer who are not receiving chemotherapy. Journal of Clinical Oncology, 27(1), 16–23 Epub 2008 Nov 17.

    Article  Google Scholar 

  • Ontario Breast Screening Program. (2001). Multidisciplinary Roles and Expectations for Breast Assessment in Ontario. Toronto: The Breast Assessment Collaborative Group.

    Google Scholar 

  • Plotogea, A., Chiarelli, A. M., Mirea, L., Prummel, M. V., Chong, N., Shumak, R. S., et al. (2013). Factors associated with wait times across the breast cancer treatment pathway in Ontario. SpringerPlus, 2(1), 388. https://doi.org/10.1186/2193-1801-2-388.

  • Punglia, R. S., Saito, A. M., Neville, B. A., Earle, C. C., & Weeks, J. C. (2010). Impact of interval from breast conserving surgery to radiotherapy on local recurrence in older women with breast cancer: retrospective cohort analysis. Bmj., 340, c845.

    Article  Google Scholar 

  • Quan, M. L., Shumak, R. S., Majpruz, V., Holloway, C. M., O’Malley, F. P., & Chiarelli, A. M. (2012). Improving work-up of the abnormal mammogram through organized assessment: results from the ontario breast screening program. Journal of Oncology Practice/ American Society of Clinical Oncology, 8(2), 107–112.

    Article  Google Scholar 

  • Rayson, D., Chiasson, D., & Dewar, R. (2004). Elapsed time from breast cancer detection to first adjuvant therapy in a Canadian province, 1999-2000. CMAJ., 170(6), 957–961.

    Article  Google Scholar 

  • Rayson, D., Saint-Jacques, N., Younis, T., Meadows, J., & Dewar, R. (2007). Comparison of elapsed times from breast cancer detection to first adjuvant therapy in Nova Scotia in 1999/2000 and 2003/04. CMAJ., 176(3), 327–332.

    Article  Google Scholar 

  • Saint-Jacques, N., Younis, T., Dewar, R., & Rayson, D. (2007 12/1906/30/received11/10/revised11/13/accepted). Wait times for breast cancer care. British Journal of Cancer, 96(1), 162–168.

  • SAS Institute Inc. (2013). Statistical Analysis Software, 9.4 ed. Cary: SAS Institute.

    Google Scholar 

  • Smith, C. R., Chiarelli, A. M., Holloway, C. M., Mirea, L., O'Malley, F. P., Blackmore, K. M., et al. (2018). The impact of organized breast assessment on survival by stage for screened women diagnosed with invasive breast cancer. The Breast, 41, 25–33.

  • Statistics Canada. Postal code conversion file plus (PCCF+), reference guide, 2014.

  • Vujovic, O., Yu, E., Cherian, A., Perera, F., Dar, A. R., Stitt, L., et al. (2009). Effect of interval to definitive breast surgery on clinical presentation and survival in early-stage invasive breast cancer. International Journal of Radiation Oncology, Biology, Physics, 75(3), 771–774.

    Article  Google Scholar 

  • Whelan, T. J., Julian, J., Wright, J., Jadad, A. R., & Levine, M. L. (2000). Does locoregional radiation therapy improve survival in breast cancer? A meta-analysis. Journal of Clinical Oncology, 18(6), 1220–1229 e-pub ahead of print 2000/03/15.

    Article  CAS  Google Scholar 

  • Whelan, T., Olivotto, I., & Levine, M. (2003). Health Canada’s Steering Committee on Clinical Practice Guidelines for the C, Treatment of Breast C. Clinical practice guidelines for the care and treatment of breast cancer: breast radiotherapy after breast-conserving surgery (summary of the 2003 update). CMAJ., 168(4), 437–439.

    PubMed  PubMed Central  Google Scholar 

  • Wolff, A. C., Hammond, M. E., Schwartz, J. N., Hagerty, K. L., Allred, D. C., Cote, R. J., et al. (2007). American Society of Clinical Oncology/College of American Pathologists guideline recommendations for human epidermal growth factor receptor 2 testing in breast cancer. Archives of Pathology & Laboratory Medicine, 131(1), 18–43.

    CAS  Google Scholar 

Download references

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.

Author information

Authors and Affiliations

  1. Prevention and Cancer Control, Cancer Care Ontario, 620 University Avenue, Toronto, Ontario, M5G 2L7, Canada

    Kristina M. Blackmore, Ashini Weerasinghe, Vicky Majpruz, Derek Muradali & Anna M. Chiarelli

  2. Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, Ontario, M4N 3M5, Canada

    Claire M. B. Holloway

  3. Department of Surgery, University of Toronto, 149 College Street, 5th Floor, Toronto, Ontario, M5T 1P5, Canada

    Claire M. B. Holloway & David McCready

  4. Phoenix Children’s Hospital, 1919 East Thomas Road, Phoenix, AZ, 85016, USA

    Lucia Mirea

  5. Dalla Lana School of Public Health, University of Toronto, 155 College Street, 6th floor, Toronto, Ontario, M5T 3M7, Canada

    Lucia Mirea & Anna M. Chiarelli

  6. Department of Laboratory Medicine, St. Michael’s Hospital, 30 Bond Street, Toronto, Ontario, M5B 1W8, Canada

    Frances P. O’Malley

  7. Prevention and Screening Services, Thunder Bay Regional Health Sciences Centre, 980 Oliver Road, Thunder Bay, Ontario, P7B 6V4, Canada

    Cathy Paroschy Harris

  8. South East Regional Cancer Program, 25 King Street, West Kingston, Ontario, K7L 5P9, Canada

    Ashley Hendry

  9. North East Regional Cancer Program, 41 Ramsey Lake Road, Sudbury, ON, P3E 5J1, Canada

    Amanda Hey

  10. South West Regional Cancer Program, 790 Commissioners Road, East London, Ontario, N6A 4L6, Canada

    Anat Kornecki

  11. North Simcoe Muskoka Regional Cancer Program, 201 Georgian Drive, Barrie, ON, L4M 6M2, Canada

    George Lougheed

  12. Waterloo Wellington Regional Cancer Program, 835 King Street, West Kitchener, Ontario, N2G 1G3, Canada

    Barbara-Anne Maier

  13. Central East Regional Cancer Program, 1 Hospital Court, Oshawa, Ontario, L1G 2B9, Canada

    Patricia Marchand

  14. Princess Margaret Cancer Centre, 610 University Ave, Toronto, Ontario, M5G 2M9, Canada

    David McCready

  15. Hamilton Niagara Haldimand Brant Regional Cancer Program, 699 Concession Street, Hamilton, Ontario, L8V 5C2, Canada

    Carol Rand

  16. North York General Hospital, 4001 Leslie St., North York, Ontario, M2K 1E1, Canada

    Simon Raphael

  17. Champlain Regional Cancer Program, 501 Smyth Road, Ottawa, Ontario, K1H 8L6, Canada

    Roanne Segal-Nadler

  18. Erie St. Clair Regional Cancer Program, 2220 Kildare Road, Windsor, Ontario, N8W 2X3, Canada

    Neelu Sehgal

  19. St. Michael’s Hospital, 30 Bond Street, Toronto, Ontario, M5B 1W8, Canada

    Derek Muradali

  20. Department of Medical Imaging, University of Toronto, 263 McCaul Street, 4th Floor, Toronto, Ontario, M5T 1W7, Canada

    Derek Muradali

Authors
  1. Kristina M. Blackmore
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ashini Weerasinghe
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Claire M. B. Holloway
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Vicky Majpruz
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Lucia Mirea
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Frances P. O’Malley
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Cathy Paroschy Harris
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Ashley Hendry
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Amanda Hey
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Anat Kornecki
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. George Lougheed
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Barbara-Anne Maier
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Patricia Marchand
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. David McCready
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Carol Rand
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. Simon Raphael
    View author publications

    You can also search for this author in PubMed Google Scholar

  17. Roanne Segal-Nadler
    View author publications

    You can also search for this author in PubMed Google Scholar

  18. Neelu Sehgal
    View author publications

    You can also search for this author in PubMed Google Scholar

  19. Derek Muradali
    View author publications

    You can also search for this author in PubMed Google Scholar

  20. Anna M. Chiarelli
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

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.

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

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

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

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

Keywords

Mots-clés

Search

Navigation