Effect of specialized diagnostic assessment units on the time to diagnosis in screen-detected breast cancer patients.
BACKGROUND
The duration of the cancer diagnostic process has considerable influence on patients' psychosocial well-being. Breast diagnostic assessment units (DAUs) in Ontario, Canada are designed to improve the quality and timeliness of care during a breast cancer diagnosis. We compared the diagnostic duration of patients diagnosed through a DAU vs usual care (UC).


METHODS
Retrospective population-based cohort study of 2499 screen-detected breast cancers (2011) using administrative health-care databases linked to the Ontario Cancer Registry. The diagnostic interval was measured from the initial screen to cancer diagnosis. Diagnostic assessment unit use was based on the biopsy and/or surgery hospital. We compared the length of the diagnostic interval between the DAU groups using multivariable quantile regression.


RESULTS
Diagnostic assessment units had a higher proportion of patients diagnosed within the 7-week target compared with UC (79.1% vs 70.2%, P<0.001). The median time to diagnosis at DAUs was 26 days, which was 9 days shorter compared with UC (95% CI: 6.4-11.6). This effect was reduced to 8.3 days after adjusting for all study covariates. Adjusted DAU differences were similar at the 75th and 90th percentiles of the diagnostic interval distribution.


CONCLUSIONS
Diagnosis through an Ontario DAU was associated with a reduced time to diagnosis for screen-detected breast cancer patients, which likely reduces the anxiety and distress associated with waiting for a diagnosis.
Division of Cancer Care and Epidemiology, Cancer Research Institute at Queen's University, 10 Stuart Street, Kingston K7L3N6, Canada.
L
L
Jiang
Cancer Care Ontario, 620 University Avenue, Toronto M5G2L7, Canada.
J
J
Gilbert
South East Regional Cancer Program, Kingston General Hospital, 76 Stuart Street, Kingston K7L2V7, Canada.
H
H
Langley
Department of Family and Community Medicine, University of Toronto, 500 University Avenue, Toronto M5G1V7, Canada.
R
R
Moineddin
Division of Cancer Care and Epidemiology, Cancer Research Institute at Queen's University, 10 Stuart Street, Kingston K7L3N6, Canada.
P A
PA
Groome
D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000473:pathology; D055088:Early Detection of Cancer; D005260:Female; D006801:Humans; D008327:Mammography / Q000379:methods*; D008403:Mass Screening; D008875:Middle Aged