Nancy Mayo and colleagues suggest that the waiting time between diagnosis and first surgery for breast cancer increased in Quebec between 1992 and 1998.1 Although this may be due to the recent reform of health services, an alternative or complementary explanation is that more women are being diagnosed following screening by mammography.
With more screening, the proportion of tumours detected early, when they are small and nonpalpable, should increase. The investigation of such cases often requires several procedures, and the referral process is likely to be associated with delays that would not be experienced by women with symptoms, especially in the absence of a formal screening program. The time between the initial step to case identification and surgery may increase, but this could still be good news.
How could this be? First, between 1992 and 1998 the proportion of women in Quebec aged 50 to 69 years who had had a mammogram during the previous year increased from 49.4% to 64.3%.2 Second, Mayo and colleagues reported that the number of in situ tumours doubled during this period, whereas the number of advanced tumours decreased.1 Third, the delay to surgery is shorter for advanced cases. Finally, these data must be interpreted within the context of a sustained decline in breast cancer mortality over this period.3 Although the delay increased both when the initial test was a mammogram and when it was a biopsy, the proportion of the latter cases was very small and decreased over time.
This opinion should not be interpreted as a denial that quality of care for cancer must be a constant preoccupation4 and that prompt access to treatment is an unequivocal right of people afflicted with this disease. Criteria for quality control of the Quebec Breast Cancer Screening Program were specifically set up to ensure that prompt investigation follows an abnormal mammogram.
Signatures
Nicole Hébert-Croteau
Médecin-conseil Institut national de santé publique du Québec Greenfield Park, Que.
Diane Villeneuve
Médecin coordonnateur Région de Montréal-Centre Programme québécois de dépistage du cancer du sein Direction de la santé publique de Montréal-Centre Montreal, Que.
References
- 1.Mayo NE, Scott SC, Shen N, Hanley J, Goldberg MS, MacDonald N. Waiting time for breast cancer surgery in Quebec. CMAJ 2001; 164 (8): 1133-8. [PMC free article] [PubMed]
- 2.Enquête sociale et de santé 1998. Quebec City: Institut de la statistique du Québec; 2000.
- 3.Brisson J, Major D. Plan de surveillance de la lutte contre le cancer du sein II : Évolution de la lutte contre le cancer du sein au Québec. Quebec City: Direction des communications, Ministère de la santé et des services sociaux; 2000.
- 4.Comité consultatif sur le cancer, Programme québécois de lutte contre le cancer. Pour lutter efficacement contre le cancer, faisons équipe. Quebec City: Ministère de la santé et des services sociaux; 1997.