Waiting times from abnormal breast screen to diagnosis in 7 Canadian provinces

Background: Delay to breast cancer diagnosis following an abnormal screenin g result is associated with anxiety and personal disruption. We assessed th e patterns and timeliness of diagnostic follow-up after breast cancer scree ning for women with abnormal results who attended organized screening progr ams in 7 provinces. Methods: Using data from the Canadian Breast Cancer Screening Database, we identified 203 141 women aged 50-69 years who underwent screening in 1996 t hrough provincially organized breast cancer screening programs in British C olumbia, Alberta, Saskatchewan, Manitoba, Ontario, Nova Scotia and Newfound land. We prospectively followed women with an abnormal screening result thr ough to the completion of the assessment process. We evaluated the waiting times from screening examination to first assessment, from screening examin ation to first imaging, from screening examination to diagnosis and from fi rst assessment to diagnosis for 13 958 women, stratified according to scree ning program, mode of detection, whether a biopsy was performed and whether cancer was diagnosed. Results: We observed considerable variations between and within programs in the time to diagnosis. The median time from screening examination to first assessment was 2.6 weeks. The median time from screening examination to di agnosis was 3.7 weeks; this time increased to 6.9 weeks for women undergoin g biopsy. Even when no biopsy was performed, 10% of the women waited 9.6 we eks or longer for a diagnosis, as compared with 15.0 weeks or longer for 10 % of the women undergoing biopsy. Among the women who had a biopsy, the use of core biopsy was associated with a shorter median time to diagnosis than was open biopsy, and those found to have cancer had shorter waiting times than women with benign biopsy findings. Interpretation: Women undergoing assessment of an abnormal breast cancer sc reening result waited many weeks for a diagnosis, especially when a biopsy was performed. To ensure that targets for timeliness, adopted nationally in 1999, are realized, improved models of care or dissemination of existing e fficient techniques to reach a diagnosis will be needed.