title: Wait times for breast cancer surgery: effect of magnetic resonance imaging and preoperative investigations on the diagnostic pathway.
abstract: OBJECTIVE
  Women with breast cancer often require an extensive diagnostic work-up. We sought to determine the overall wait time, from the patient's perspective, from identification of an imaging abnormality to definitive treatment. The objective was to identify which factors contribute to overall wait time in women with breast cancer.
  
  
  METHODS
  A retrospective chart review in a tertiary care center was performed to identify all women who had breast surgery for invasive carcinoma and ductal carcinoma in situ. We recorded the dates of first imaging abnormality, first biopsy, subsequent imaging and biopsy, first consultation with any physician at the cancer center, first surgical consultation, and date of surgery. Clinical data that might influence these dates were then extracted. Wait times were calculated and factors associated with wait times were described.
  
  
  RESULTS
  Eligible consecutive women with a cancer diagnosis (n = 264) were identified. The median time between first imaging abnormality and definitive surgery was 79 days. The median time from first surgical consultation to surgery was significantly longer in women who underwent magnetic resonance imaging and in women who underwent initial imaging outside of our tertiary care center (P < .05). On multivariable analysis, the modifiable factors associated with prolonged wait times included number of preoperative clinic visits, number of visits to radiology, and initial imaging outside of our center (P < .05).
  
  
  CONCLUSIONS
  Extensive diagnostic work-up is an important factor that affects the time to definitive surgery. A more integrated approach using a rapid diagnostic clinic for tissue diagnosis initially, followed by facilitated preoperative evaluation, may potentially decrease wait times in breast evaluation.
authors: Odette Cancer Centre and Sunnybrook Health Sciences Centre; University of Toronto; and Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
authors: Carolyn
authors: C
authors: Nessim
authors: Odette Cancer Centre and Sunnybrook Health Sciences Centre; University of Toronto; and Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
authors: Julian
authors: J
authors: Winocour
authors: Odette Cancer Centre and Sunnybrook Health Sciences Centre; University of Toronto; and Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
authors: Diana P M
authors: DP
authors: Holloway
authors: Odette Cancer Centre and Sunnybrook Health Sciences Centre; University of Toronto; and Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
authors: Refik
authors: R
authors: Saskin
authors: Odette Cancer Centre and Sunnybrook Health Sciences Centre; University of Toronto; and Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada claire.holloway@sunnybrook.ca.
authors: Claire M B
authors: CM
authors: Holloway
mesh_terms: D001943:Breast Neoplasms / Q000175:diagnosis / Q000601:surgery*; D018270:Carcinoma, Ductal, Breast / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D009864:Ontario; D057234:Preoperative Period; D014850:Waiting Lists