Imagine the anxiety: a woman receives notice that her screening mammogram was abnormal. A second test is now needed to determine what's wrong. And in the meantime, she wonders if the news will be breast cancer.
To reduce the stress associated with the waiting period for diagnosis, the Screening Mammography Program of BC (SMPBC) – a program of the BC Cancer Agency - has introduced "Fast Track." This province-wide program greatly reduces the time between a first abnormal screening mammogram and the tests that will lead to a final diagnosis. Fast Track aims to have the majority of women who need it have a second, more detailed mammogram or ultrasound within one week.
"This program not only addresses a woman's physical well-being by speeding up the time between screening and diagnosis, but also aims to reduce the emotional stress related to waiting for test results," explains Dr. Andy Coldman of the BC Cancer Agency.
In 1995, the SMPBC took a look at the time it was taking to reach a diagnosis after an abnormal mammogram, and found that after an abnormal screen, 85 percent of women have further breast imaging, and 15 percent have imaging, a surgical consult, and then a biopsy. Women were waiting many weeks for a final diagnosis. This was causing anxiety, personal disruption, and family disruption.
Five pilot projects were organized around the province to try different ways to reduce the time from an abnormal screen to a diagnosis. In four of the five communities, there was a significant reduction in the time to diagnosis, with the most dramatic reduction in Nanaimo. Here, the SMP contacted the regional diagnostic facility in the case of an abnormal screen, and the facility then arranged more tests directly with the patient. This successful model is now being used across the province.
Previously, results from a screening mammogram were first sent to a patient's family physician, who would then request an appointment with the patient before making a referral to a diagnostic centre. Now, with the support of family doctors, results from abnormal screening mammograms can be sent directly to a diagnostic facility, who will call the woman directly for an appointment. The family doctor receives an interim report and results.
About five percent of BC women who have a screening mammogram will need a second mammogram; one percent will also require a biopsy. A pilot project in 2001 to test "Fast Track" found that the time to diagnosis was reduced from 23 days to six days if a biopsy wasn't needed, and from 53 days to 22 days if a biopsy was required.
In the Canadian Breast Cancer Foundation's recent report, Uncovering the gaps: An inquiry of breast care in British Columbia. The Journey to Supportive Care, early detection of breast cancer was seen by those surveyed to offer a better chance of a cure.
"'Smaller tumors earlier,'is a key education message that we've learned, from caregivers in the medical community, that can equal the best chance of success and survival for a woman who is diagnosed with breast cancer," says Jan Engemoen, executive director, BC Chapter of the Canadian Breast Cancer Foundation. "With 'Fast Track,' we can start closing the gap on the 'earlier' part. The 'Fast Track' program is such a positive step for the health of women in this province who now receive diagnostic information much earlier."
This program was first piloted in Nanaimo, then extended to Comox, Penticton, Prince George and Vernon. More than 900 family doctors across the province are now involved in this new system.
The Screening Mammography Program of BC is a program of the BC Cancer Agency. The BC Cancer Agency, a part of the Provincial Health Services Authority, is committed to reducing the incidence of cancer, reducing the mortality from cancer, and improving the quality of life of those living with cancer. It provides a comprehensive cancer control program for the people of British Columbia by working with community partners to deliver a range of oncology services, including prevention, early detection, diagnosis and treatment, research, education, supportive care, rehabilitation and palliative care. The BC Cancer Research Centre conducts research into the causes and cures for cancer.
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