Breast cancer diagnosis and treatment wait times in specialized diagnostic units compared with usual care: a population-based study
Background Breast assessment sites (bass) were developed to provide expedited and coordinated care for patients being evaluated for breast cancer (bca) in Ontario. We compared the diagnostic and treatment intervals for patients diagnosed at a bas and for those diagnosed through a usual care (uc) route.
Methods This population-based, cross-sectional study of patients diagnosed with bca in Ontario during 2007–2015 used linked administrative data. “Diagnostic interval” was the time from the earliest cancer-related health care encounter before diagnosis to diagnosis; “treatment interval” was the time from diagnosis to treatment. Diagnosis at a bas was determined from the patient’s biopsy and mammography institutions. Interval lengths for the bas and uc groups were compared using multivariable quantile regression, stratified by detection method.
Results The diagnostic interval was shorter for patients who were bas-diagnosed than for those who were uc-diagnosed, with adjusted median differences of –4.0 days [95% confidence interval (ci): –3.2 days to –4.9 days] for symptomatic patients and –5.4 days (95% ci: –4.7 days to –6.1 days) for screen-detected patients. That association was modified by stage at diagnosis, with larger differences in patients with early-stage cancers. In contrast, the treatment interval was longer in patients who were bas-diagnosed than in those who were uc-diagnosed, with adjusted median differences of 4.2 days (95% ci: 3.8 days to 4.7 days) for symptomatic patients and 4.2 days (95% ci: 3.7 days to 4.8 days) for screen-detected patients.
Conclusions Diagnosis of bca through a bas was associated with a shorter diagnostic interval, but a longer treatment interval. Although efficiencies in the diagnostic interval might help to reduce distress experienced by patients, the longer treatment intervals in patients who are bas-diagnosed remain a cause for concern.