Waiting times from abnormal breast screen to diagnosis in 7 Canadian provinces.

BACKGROUND: Delay to breast cancer diagnosis following an abnormal screening result is associated with anxiety and personal disruption. We assessed the patterns and timeliness of diagnostic follow-up after breast cancer screening for women with abnormal results who attended organized screening programs in 7 provinces. METHODS: Using data from the Canadian Breast Cancer Screening Database, we identified 203,141 women aged 50-69 years who underwent screening in 1996 through provincially organized breast cancer screening programs in British Columbia, Alberta, Saskatchewan, Manitoba, Ontario, Nova Scotia and Newfoundland. We prospectively followed women with an abnormal screening result through to the completion of the assessment process. We evaluated the waiting times from screening examination to first assessment, from screening examination to first imaging, from screening examination to diagnosis and from first assessment to diagnosis for 13,958 women, stratified according to screening program, mode of detection, whether a biopsy was performed and whether cancer was diagnosed. RESULTS: We observed considerable variations between and within programs in the time to diagnosis. The median time from screening examination to first assessment was 2.6 weeks. The median time from screening examination to diagnosis was 3.7 weeks; this time increased to 6.9 weeks for women undergoing biopsy. Even when no biopsy was performed, 10% of the women waited 9.6 weeks or longer for a diagnosis, as compared with 15.0 weeks or longer for 10% of the women undergoing biopsy. Among the women who had a biopsy, the use of core biopsy was associated with a shorter median time to diagnosis than was open biopsy, and those found to have cancer had shorter waiting times than women with benign biopsy findings. INTERPRETATION: Women undergoing assessment of an abnormal breast cancer screening result waited many weeks for a diagnosis, especially when a biopsy was performed. To ensure that targets for timeliness, adopted nationally in 1999, are realized, improved models of care or dissemination of existing efficient techniques to reach a diagnosis will be needed.

Nova Scotia Breast Screening Program experience: use of needle core biopsy in the diagnosis of screening-detected abnormalities.

PURPOSE: To evaluate a mammography screening program that uses a multidisciplinary team approach and needle core biopsy. MATERIALS AND METHODS: A total of 10,000 asymptomatic women (aged 40-74 years) underwent screening in the Nova Scotia Breast Screening Program between June 1991 and April 1994. Women aged 50-69 years were the target group. All mammograms were read by one of four radiologists. Patients with abnormal screening findings underwent work-up, which included needle core biopsy, at one of two diagnostic centers. RESULTS: Of 10,000 women, 2,794 were aged 40-49 years; 4,097, 50-59 years; 2,941, 60-69 years; and 168, 70-74 years, with 3.9, 6.4, 12.2, and 23.8 cancers detected per 1,000 patients, respectively. The overall rate was 7.7 cancers detected per 1,000 patients. Abnormalities were detected at screening in 838 patients (8.4%), 181 of whom underwent open surgery, with malignancy diagnosed in 77 (42%). Sixty-one (79%) of 77 patients had stage 0 or I cancer. In 43 (72%) of 60 patients in whom node status was assessed, findings were negative. CONCLUSION: A screening program with needle core biopsy and a multidisciplinary team approach to diagnosis is effective.

Stereotaxic needle core biopsy of breast lesions using a regular mammographic table with an adaptable stereotaxic device.

OBJECTIVE: Fine-needle aspiration and stereotaxic needle core biopsy (SNCB) are techniques used in the workup of breast lesions suggestive of cancer. Many surgeons are reluctant to rely on fine needle results, and until now, SNCB could be done only with a dedicated biopsy table. Our study was done to determine whether SNCB could be performed safely and effectively with a regular mammography unit and an added stereotaxic device. SUBJECTS AND METHODS: SNCB was performed on 254 patients by using a Siemens Mammomat 2 regular mammography table with an added stereotaxic device. Patients were referred from a breast screening center, a local tertiary care center, and from our own center. Patients who had unequivocal histopathologic evidence of a benign process (133 of 254 patients) did not undergo surgical biopsy and are being followed up mammographically. The remainder (121 patients) all had surgical biopsies. RESULTS: Sufficient material for histologic analysis was obtained in 249 (98%) of 254 cases. In 31 of 254 cases, sampling was problematic. This group comprised cases in which the patient moved within the compression device, the mammographic and histologic diagnoses were discordant, or calcifications were not present in the core sample when the indication for SNCB was the presence of microcalcifications. This group all had open biopsies. In 25 of 254 cases, the pathologic findings were suggestive of cancer. Cancer was detected in 11 of these cases on open biopsy. Of the 14 benign cases, 11 showed atypical features or ductal hyperplasia on open biopsy. Malignant tumor was diagnosed in 60 of 254 cases by SNCB. Corresponding malignant tumor was seen in 59 of 60 of the open biopsy specimens. CONCLUSION: The SNCB technique is not limited to use on a dedicated biopsy table but can be readily adapted to a regular mammography unit. It is a safe, reliable and cost-effective procedure that often spares the patient a surgical procedure.

Sonar evidence of early pregnancy failure in patients with twin conceptions.

During a four-year period 30 patients were diagnosed by sonar in the first trimester of pregnancy as having twin conceptions. Of these 30 patients, 14 eventually gave birth to twins. Eleven of the remaining 16 patients were found to have a normal pregnancy and a coexistent blighted ovum (empty sac), and ultimately all but one gave birth to a single baby; the eleventh patient aborted a fresh fetus at 25 weeks of gestation. Of the last five patients, four were diagnosed as having twin blighted ova, and one a blighted ovum and missed abortion; these five patients either aborted spontaneously or had an elective termination of pregnancy. The results suggest that the incidence of twin conceptions is higher than commonly accepted figure of 1 in 80.