Time to diagnosis

Why is it important? A timely and well-coordinated diagnostic response following an abnormal breast cancer screening result is critical because a delayed diagnostic assessment could worsen prognosis and reduce the chance of survival.¹ Not all individuals who receive an abnormal screening result are diagnosed with breast cancer. A confirmed diagnosis requires additional diagnostic procedures such as additional imaging, a core or open biopsy and fine needle aspiration. The diagnostic interval, which is the duration of time from notification of an abnormal screening result to a definitive diagnosis, can be affected by the type of diagnostic tests performed, the capacity of the provincial and territorial screening programs, patient-related factors such as geographic location, and complexity of the case. This indicator can be improved by effective patient navigation, the incorporation of care routines, enhanced coordination of referrals, and fast-tracking cases based on severity of conditions.²

Indicator definition: The percentage of participants with diagnosis within the target wait times:

• 5 weeks for diagnosis not requiring a tissue biopsy
• 7 weeks for diagnosis requiring a tissue biopsy

Target:

• No tissue biopsy: ≥90% within 5 weeks
• With tissue biopsy: ≥90% within 7 weeks

Measurement timeframe:

• January 1, 2019 to December 31, 2019
• January 1, 2020 to December 31, 2020

Indicator calculation:

• No tissue biopsy
  • Numerator: The number of confirmed diagnoses occurring within 5 weeks of screening date.
  • Denominator: The total number of abnormal screens in the measurement timeframe, where tissue biopsy is not performed.
• With tissue biopsy
  • Numerator: The number of confirmed diagnoses occurring within 7 weeks of screening date.
  • Denominator: The total number of abnormal screens in the measurement timeframe, where tissue biopsy is performed.

COVID-19 considerations: Although breast cancer screening and diagnostic services have resumed, the temporary suspension of breast cancer screening and diagnostic procedures early in the pandemic did create a disruption in breast cancer diagnoses. A month-to-month trend on the number of breast cancer diagnosis showed that in April 2020, 31% fewer new breast cancer cases were diagnosed compared to the 2015-19 average. It is important for breast screening programs and diagnostic services to use tailored strategies such as risk-based approaches to reduce backlogs for diagnostic services.

Percentage of abnormal screens among individuals aged 50-74 that had a definitive diagnosis without biopsy within 5 weeks, by jurisdiction — 2019 and 2020

_{Data table and footnotes}

The percentage of individuals with abnormal screens who received a definitive diagnosis within 5 weeks without a biopsy ranged from 70.4% in Prince Edward Island to 94.9% in Alberta in 2019 and 73% in New Brunswick to 93.8% in Alberta in 2020. Alberta and Ontario were the only provinces that met the ≥90% target in both 2019 and 2020. While most jurisdictions did not meet the target of ≥90%, the performance of this indicator within jurisdictions either improved slightly or remained relatively consistent between 2019 and 2020.

Percentage of abnormal screens among individuals aged 50-74 that had a definitive diagnosis with biopsy within 7 weeks, by jurisdiction — 2019 and 2020

_{Data table and footnotes}

The percentage of individuals with abnormal screening results who required biopsy and received a definitive diagnosis within 7 weeks ranged from 47.6% to 91.5% in 2019 and 53.7% to 93.2% in 2020. Alberta was the only province that met the national target of ≥90% in both 2019 and 2020.