Waiting for a diagnosis after an abnormal screening mammogram

Regular screening mammography reduces breast cancer mortality.(1-3) As a re sult, since 1987, organized breast cancer screening programs have been esta blished in many jurisdictions in Europe, Australia and in all Canadian prov inces. The process of screening does not make a diagnosis of cancer but rat her identifies women with abnormalities who require additional diagnostic e valuation. It is recognized that reporting an abnormal screening result cau ses stress and anxiety for women.(4-7) Delays in determining a definitive d iagnosis may interfere with a woman's productivity and may influence her co mpliance with re-screening.(7,8) The responsibility for evaluation of an abnormal screening result rests wit h the screening program in the United Kingdom (UK) and Australia.(9,10) Dia gnosis is accomplished by referral to interdisciplinary assessment clinics which often operate one or two days per week and are affiliated with one or more screening centres. In Canada, for historical reasons, except in certain areas,(11,12) women wi th abnormalities identified during a visit to an organized breast cancer sc reening program are referred back to their family physician who rakes prima ry responsibility for organizing the diagnostic evaluation, including refer ral for diagnostic imaging and if required, surgical consultation and biops y. Concern has been expressed that such a system could be associated with i nappropriate delays in the assessment of an abnormal creening mammogram(4.1 3-16) but, to date, there has been no published systematic evaluation of th e timeliness of investigation after an abnormal screening mammogram in a Ca nadian organized breast screening program. This report details the sequence of steps and the magnitude of regional variation in the timeliness of asse ssment for women with abnormal screening mammograms detected through the Sc reening Mammography Program of British Columbia (SMPBC) in 1993-94.