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Wait for breast cancer diagnosis too long, report says

Doctors rushing with a patient on stretcher in a hospital

Joshua Hodge Photography/iStockphoto

Women across Canada are waiting weeks longer than they should be to find out if they have breast cancer, according to a sweeping new report evaluating the country's efforts to fight all types of cancer.

No province is meeting a national benchmark for how quickly the majority of patients receive a diagnosis after an abnormality is spotted during a breast screening, with Quebec missing the target by the widest margin.

Experts said the lag is unlikely to affect how breast-cancer patients are treated or how long they survive, but it leaves some women to endure weeks of uncertainty.

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"Is it something that is going to make a difference to a woman's survival? Probably not. Is it going to make a difference to a woman's peace of mind … indeed it is," said Heather Bryant, the vice-president of cancer control for the Canadian Partnership Against Cancer, the federally funded agency that published its annual evaluation of the country's cancer-fighting efforts on Wednesday.

Dr. Bryant said women whose screening results cause doctors the most concern generally get swifter diagnoses.

"Women that have the longer wait times are the ones [where] everybody's pretty comfortable that this is probably benign. But nevertheless, for the woman herself, you want that put to bed as soon as you can," she said.

The report examined everything from prevention and screening programs to wait times and long-term outcomes in a bid to find and fix the shortfalls in a system that is largely succeeding in improving survival rates for the most common forms of the disease.

Five-year survival rates improved for breast, lung, colorectal, prostate and pancreatic cancers between 1992-94 and 2006-08, the most recent years studied.

Wait times for diagnoses of breast and colorectal cancer were among the shortcomings flagged in the report.

In the case of breast cancer, the goal is to ensure nine out of 10 women aged 50 to 69 at average risk of cancer receive a diagnosis in seven weeks if they need a biopsy, or five weeks if they do not.

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Even the top-performing provinces – Prince Edward Island, New Brunswick and Alberta – fell well short of the seven-week goal in 2011, the most recent year evaluated in the report. Those provinces provided results to nine out of 10 women in 9.6 weeks, 12 weeks and 12.1 weeks, respectively.

Women waited longest for results in Quebec (17.6 weeks), Newfoundland and Labrador (17 weeks) and Manitoba (16.4 weeks).

Data on that measure were unavailable for Yukon and Ontario.

Jean François Boileau, a surgical oncologist at Jewish General Hospital in Montreal, said the long wait between between an abnormal test result and a diagnosis are troubling, but it is not clear if it makes a difference medically.

"I'm not trying to justify these waits at all, but the reality is we don't have good evidence that reducing that time gap makes a difference on the effectiveness of treatment and survival," he said.

But Dr. Boileau was quick to add that "what is unquestionable is that the wait for results is hell for patients. The psychological impact is enormous."

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He has worked in three different provinces but said he could not explain why Quebec has longer delays, but added that, as a clinician, "If my patients had long delays like that, I would not be happy."

Sri Navaratnam, chief executive officer of CancerCare Manitoba, said a review of the province's pathology services in 2011 led to longer waits that year.

The province, which is aiming to reduce the time between the first hints of all cancers and the start of treatment to 60 days, performed better on the breast-cancer measure in 2010 and 2012, she said.

"There is no scientific evidence to say whether it should be five weeks or six weeks or seven weeks," Dr. Navaratnam said of the time between an abnormal result and a diagnosis. "The earlier the better."

Canada is catching and treating the vast majority of breast cancers early, the report says.

Fewer than 5 per cent of patients were diagnosed with breast cancer at stage four – after the disease had metastasized, or spread to other organs.

Still, patients deserve to know whether they have cancer as soon as possible, Dr. Navaratnam said.

Even when Manitoba meets its larger 60-day goal, "that's 59 sleepless nights," she added.

With a report from André Picard

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Kelly Grant is a health reporter with The Globe and Mail. More


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