Background: Diagnostic delays following abnormal breast screening are associated with substantial anxiety and personal and family disruption. We identified and assessed the diagnostic process following an abnormal breast screening examination in Canada.
Methods: Women aged 50-69 undergoing screening mammography with or without a clinical breast examination in seven organized provincial programs between January 1, 1996 and December 31, 1996 were identified (N=203,338). Timeliness to diagnosis was assessed in N=14,105 women with an abnormal screen who completed subsequent diagnostic follow-up. Diagnostic times were calculated from the date of the abnormal screen, and were further stratified according to program, mode of detection, and whether a biopsy was included in the assessment.
Results: After an abnormal screen, median time to first assessment varied from 1.9-3.9 weeks, depending on the program. Overall median times from abnormal screen to diagnosis ranged from 3.1 to 5.3 weeks, with 10% of women waiting in excess of 8.4 to 22.7 weeks to obtain a final diagnosis depending on the program. Requiring a biopsy lengthened the time to diagnosis to a median of 6.0 to 9.6 weeks. If biopsy was required, women attending programs which more frequently employed core biopsy had shorter median times to diagnosis.
Interpretation: Women undergoing diagnostic follow-up after an abnormal screen waited many weeks for a final diagnosis, especially if a biopsy was required. A set of definitions and timeliness targets is proposed along with a discussion of future directions for monitoring and achieving targets.
Learning Objectives: At the conclusion of the session the participant will be able to recognize the high level of variability in the time required to obtain a final diagnosis after an abnormal breast screen, define criteria for assessing timeliness of diagnosis following abnormal findings discovered at screening, and discuss recommendations for timeliness as outlined by Canadian organized screening programs and those in other nations
Keywords: Breast Cancer Screening, Health Care Delivery
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: Provincial organized breast screening programs
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.