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Breast Cancer Screening Follow-up

Key findings

In 2016, over 6,400 Ontario women age 50 to 74 who had an abnormal Ontario Breast Screening Program (OBSP) mammogram and needed tissue biopsy for a definitive diagnosis were diagnosed within the recommended 7 weeks of the abnormal result [1]. This number represents an increase of 7 percentage points, from 73% in 2013 to 80% in 2016.

Measure:  Follow-up: percentage of Ontario screen-eligible women, age 50 to 74, with an abnormal OBSP screening mammogram result who needed a tissue biopsy and were diagnosed (benign or with cancer) within 7 weeks of the abnormal screen date

 

Desired Direction:

 

An image of an arrow pointing upwards. This indicates that desired direction for this action is upwards.

 

As of this Report:

 

An image of an arrow pointing straight in a yellow box. This indicates that there has been no increase or decrease in performance over the previous periods identified and this action is below but approaching target or has notable regional variation.

What is breast cancer screening?

  • Cancer screening is testing for people who may be at risk of getting cancer, but who have no symptoms and generally feel fine. It is not meant to diagnose cancer. Instead, it helps determine which people are more likely to develop cancer in the future. Ontario operates screening programs for 3 types of cancer: breast, cervical and colorectal.
  • The purpose of breast cancer screening is to find cancer at an early stage, when it may be smaller and easier to treat.
  • A mammogram uses low-dose X-rays to produce images of the breast [2]. A breast magnetic resonance imaging (MRI) scan uses radio waves and a magnetic field to create cross-sectional images of the breast and an intravenous contrast agent (e.g., dye) is used most of the time. Both tests can find breast cancers when they are small, less likely to have spread and more likely to be treated successfully.
  • Breast cancer screening with mammography is recommended every 2 years for most women age 50 to 74 [3].
  • Breast cancer screening with mammography and breast MRI (or screening breast ultrasound if MRI is not medically appropriate) is recommended every year for women age 30 to 69 who are identified as being at high risk for breast cancer [4].
  • Most women with an abnormal mammogram result will not necessarily have breast cancer [2]. More tests are needed after an abnormal mammogram result to determine whether cancer is present.
  • Diagnostic assessment includes additional radiological or surgical procedures, such as diagnostic mammography, ultrasonography, and core or open surgical biopsy.
  • In Ontario, breast cancer screening occurs through both OBSP (Ontario’s population-based breast cancer screening program) and non-OBSP sites. For a map of locations, see Breast cancer screening participation.

I believe screening is very important: my cancer was discovered during a routine screening test and this this early detection allowed me to get the required treatment quickly and effectively.

Wendy D., Patient/Family Advisor

Figure 1. Ontario Breast Screening Program (OBSP) breast assessment sites across Ontario

 

Figure 2. Percentage of Ontario screen-eligible women with an abnormal Ontario Breast Screening Program (OBSP) screening mammogram result, age 50 to 74, who needed a tissue biopsy and were diagnosed within 7 weeks of the abnormal screen date, by Local Health Integration Network (LHIN), 2013 to 2016

More information regarding the methodology is available.

Report date: November 2017

Data source: ICMS, OHIP CHDB, OCR, RPDB, PCCF+ version 6D

Prepared by: Analytics, Cancer Screening,  P&CC

Note:

  1. Please refer to technical documentation.

Figure 3. Percentage of Ontario screen-eligible women with an abnormal Ontario Breast Screening Program (OBSP) screening mammogram result, age 50 to 74, who needed a tissue biopsy and were diagnosed within 7 weeks of the abnormal screen date, by age group, 2013 to 2016

More information regarding the methodology is available.

Report date: November 2017

Data source: ICMS, OHIP CHDB, OCR, RPDB, PCCF+ version 6D

Prepared by: Analytics, Cancer Screening,  P&CC

Note:

  1. Please refer to technical documentation.

Data Table 1. Ontario Breast Screening Program (OBSP) breast assessment sites across Ontario

LHIN Organization Updated Name Address City Postal Code Longitude Latitude
Central York Radiology Consultants - 1333 Sheppard Avenue East North York M2J1V1 -79.36141334 43.77142945
Central North York General - Branson Site - 555 Finch Avenue West North York M2R1N5 -79.44738179 43.77161042
Central East Rouge Valley Health System - Centenary Site Scarborough and Rouge Hospital - Centenary 2867 Ellesmere Road Scarborough M1E4B9 -79.2049642 43.78008999
Central East Scarborough General Hospital Scarborough and Rouge Hospital - General 3050 Lawrence Avenue East Scarborough M1P2V5 -79.24750511 43.75615674
Central Markham Stouffville Hospital - 381 Church Street Markham L3P7P3 -79.22933285 43.88561671
Central East Lakeridge Health - Oshawa Site - 1 Hospital Court Oshawa L1G2B9 -78.86761362 43.9063207
Central East Northumberland Hills Hospital - 1000 Depalma Drive Cobourg K9A5W6 -78.19845266 43.97669503
Central Dixie X-Ray Associates Limited - Finch - 2065 Finch Avenue West North York M4N2V7 -79.52328761 43.75573938
Central East Lakeridge Health - Bowmanville Site - 47 Liberty Street Bowmanville L1C2N4 -78.6818403 43.91443513
Mississauga Halton Queensway Health Centre - 150 Sherway Drive Etobicoke M9C1A5 -79.56281351 43.60930206
Central West Etobicoke General Hospital - 89 Humber College Boulevard Etobicoke M9V1R8 -79.59763496 43.73074354
Central Southlake Regional Health Centre - 596 Davis Drive Newmarket L3Y2P9 -79.45252346 44.06103404
Central East Uxbridge Cottage Hospital - 4 Campbell Drive Uxbridge L9P1S4 -79.12560612 44.10228024
Central East Peterborough Regional Health Centre - 1 Hospital Drive Peterborough K9J7C6 -78.34502062 44.30076655
Champlain Hawkesbury and District General Hospital - 1111 Ghislain Street Hawkesbury K6A3G5 -74.60583368 45.59821321
Central East Ross Memorial Hospital - 10 Angeline Street North Lindsay K9V4M8 -78.75133464 44.35186949
Champlain Pembroke Regional Hospital - 705 Mackay Street Pembroke K8A1G8 -77.10810272 45.81361755
Central East Rouge Valley Health System - Ajax Lakeridge Health - Ajax Pickering Hospital 580 Harwood Avenue South Ajax L1S2J4 -79.0153466 43.83700411
Champlain Renfrew Victoria Hospital - 499 Raglan Street North Renfrew K7V1P6 -76.69725269 45.48246353
Central Vaughan Imaging Consultants - 8333 Weston Road Woodbridge L4L8E2 -79.55089013 43.80435602
Champlain Merivale Medical Imaging - 1370 Clyde Avenue Nepean K2G3H8 -75.73966908 45.36007309
Champlain Hopital Montfort - 713 Chemin Montreal Ottawa K1K0T2 -75.63910369 45.44567172
Champlain Winchester District Memorial Hospital - 566 Louise Street Winchester K0C2K0 -75.35246605 45.08872391
Central Mackenzie Health - 10 Trench Street Richmond Hill L4C4Z3 -79.4503672 43.86997222
Erie St. Clair Bluewater Health -Norman Site - 89 Norman Street Sarnia N7T6S3 -82.39130926 42.97620546
Champlain Ottawa Hospital - Civic Campus - 1053 Carling Avenue Ottawa K1Y4E9 -75.72162056 45.391601
Erie St. Clair Windsor Regional Hospital - Metropolitan Campus - 1995 Lens Avenue Windsor N8W1L9 -82.99747871 42.30081887
Central West Brampton Civic Hospital - 2100 Bovaird Drive East Brampton L6R3J7 -79.74243683 43.7459333
Erie St. Clair Leamington District Memorial Hospital Erie Shores HealthCare - Leamington 194 Talbot Street West Leamington N8H1N9 -82.61497214 42.04947486
Champlain Queensway Carleton Hospital - 3045 Baseline Road Ottawa K2H8P4 -75.8044177 45.3340679
Hamilton-Niagara-Haldimand-Brant Brantford General Hospital - 200 Terrace Hill Street Brantford N3R1G9 -80.27623898 43.15275216
Erie St. Clair Public General Hospital Society of Chatham - 80 Grand Avenue West Chatham N7L1B7 -82.19434554 42.40574261
Hamilton-Niagara-Haldimand-Brant St. Joseph's Healthcare Hamilton - Charlton Campus - 50 Charlton Avenue East Hamilton L8N4A6 -79.87000095 43.24933819
Hamilton-Niagara-Haldimand-Brant Juravinski Hospital - 711 Concession Street Hamilton L8V1C3 -79.84628476 43.2394648
Hamilton-Niagara-Haldimand-Brant Greater Niagara General Hospital - 5546 Portage Road Niagara Falls L2E6X2 -79.0917757 43.09392935
Mississauga Halton Credit Valley Hospital - 2200 Eglinton Avenue West Mississauga L5M2N1 -79.73210658 43.53598895
Hamilton-Niagara-Haldimand-Brant St. Catharines General Hospital - 1200 Fourth Avenue St. Catharines L2S0A9 -79.28361693 43.15495622
Mississauga Halton Dixie X-Ray Associates - Highpoint - 3461 Dixie Road Mississauga L4Y3X4 -79.59828937 43.61953699
Mississauga Halton Oakville-Trafalgar Memorial Hospital - 327 Reynold Street Oakville L6J3L7 -79.6744369 43.45325676
North East Sault Area Hospital - 750 Great Northern Road Sault Ste Marie P6B0A8 -84.31931011 46.54866225
North East Kirkland and District Hospital - 145 Government Road East Kirkland Lake P2N3P4 -80.02076022 48.15619588
North Simcoe Muskoka Royal Victoria Regional Health Centre - 201 Georgian Drive Barrie L4M6M2 -79.66197925 44.4161345
North East Timmins & District Hospital - 700 Ross Avenue East Timmins P4N8P2 -81.31284752 48.48595683
South East Hotel-Dieu Hospital (Kingston) - 166 Brock Street Kingston K7L5G2 -76.48590388 44.23109852
South West Grey Bruce Health Services - Owen Sound - 1800 8Th Street East Owen Sound N4K6M9 -80.91167079 44.5675377
Hamilton-Niagara-Haldimand-Brant St. Joseph's Healthcare Hamilton - King Campus - 2757 King Street East Hamilton L8G5E4 -79.77437276 43.22036984
South West South Bruce Grey Health Centre - Walkerton Site - 21 Mcgivern Street West Walkerton N0G2C0 -81.15221027 44.12341098
South West Listowel Memorial Hospital - 255 Elizabeth Street East Listowel N4W2P5 -80.9490693 43.73231204
South West Stratford General Hospital - 46 General Hospital Drive Stratford N5A2Y6 -80.99551135 43.3686678
South West Strathroy Middlesex General Hospital - 395 Carrie Street Strathroy N7G3J4 -81.63463825 42.96092272
South West St. Joseph's Hospital (London) - 268 Grosvenor Street London N6A4V2 -81.25424763 42.99999979
South West Woodstock General Hospital - 310 Juliana Drive Woodstock N4V0A4 -80.75372857 43.10865133
Toronto Central St. Michael's Hospital - 30 Bond St Toronto M5B1W8 -79.37734585 43.65371677
Toronto Central Mount Sinai Hospital - 600 University Avenue Toronto M5G1X5 -79.38983222 43.6578405
Toronto Central Princess Margaret Hospital - 610 University Avenue Toronto M5G2M9 -79.38998296 43.6581959
South East Belleville General Hospital - 265 Dundas Street East Belleville K8N5A9 -77.36546021 44.16352707
Waterloo Wellington Grand River Hospital - Freeport Site - 3570 King Street East Kitchener N2A2W1 -80.41195928 43.42378617
Hamilton-Niagara-Haldimand-Brant Welland County General Hospital - 65 Third Street Welland L3B4W6 -79.25097683 42.98071983
Mississauga Halton Georgetown Hospital - 1 Princess Anne Drive Georgetown L7G2B8 -79.93249713 43.64393706
Central North York General - General Site - 4001 Leslie Street North York M2K1E1 -79.36415623 43.76938223
North East Weeneebayko General Hospital - 19 Hospital Drive Moose Factory P0L1W0 -80.60070409 51.26001687
North East Sensenbrenner Hospital - 101 Progress Crescent Kapuskasing P5N3H5 -82.42882023 49.4248109
South East Trenton Memorial Hospital - 242 King Street Trenton K8V5S6 -77.58860464 44.09871637
North East Health Sciences North - 865 Regent Street South Sudbury P3E3Y9 -81.00711216 46.47378303
North East Hopital Notre-Dame Hospital - 1405 Edward Street Hearst P0L1N0 -83.6635342 49.68407192
Toronto Central Women's College Hospital - 76 Grenville Street Toronto M5S1B2 -79.3877272 43.66166306
North East North Bay Regional Health Centre - 50 College Drive North Bay P1B5A4 -79.4616302 46.30946406
Hamilton-Niagara-Haldimand-Brant Burlington Ultrasound and Radiology Wentworth-Halton X-Ray & Ultrasound - Burlington South 760 Brant Street Burlington L7R4B7 -79.80872901 43.33306634
North West Thunder Bay Regional Health Sciences Centre - 980 Oliver Road Thunder Bay P7B6V4 -89.26826474 48.42447222
Toronto Central Sunnybrook Health Sciences Centre - 2075 Bayview Avenue Toronto M4N3M5 -79.37787537 43.72193764

 

Data Table 2. Percentage of Ontario screen-eligible women with an abnormal Ontario Breast Screening Program (OBSP) screening mammogram result, age 50 to 74, who needed a tissue biopsy and were diagnosed within 7 weeks of the abnormal screen date, by Local Health Integration Network (LHIN), 2013 to 2016

LHIN Rate (%) in 2013 Numerator in 2013 Denominator in 2013 Lower confidence interval in 2013 Upper confidence interval in 2013 Rate (%) in 2014 Numerator in 2014 Denominator in 2014 Lower confidence interval in 2014 Upper confidence interval in 2014 Rate (%) in 2015 Numerator in 2015 Denominator in 2015 Lower confidence interval in 2015 Upper confidence interval in 2015 Rate (%) in 2016 Numerator in 2016 Denominator in 2016 Lower confidence interval in 2016 Upper confidence interval in 2016
Ontario 73.2 4,852 6,625 72.2 74.3 76.9 5,728 7,451 75.9 77.8 79.3 6,229 7,852 78.4 80.2 79.7 6,417 8,051 78.8 80.6
Erie St. Clair 73.5 330 449 69.3 77.7 73.0 367 503 69.0 76.9 85.6 525 613 82.8 88.5 89.5 530 592 87.0 92.1
South West 76.1 432 568 72.5 79.7 76.5 472 617 73.1 79.9 83.8 464 554 80.6 86.9 89.5 550 612 87.4 92.3
Waterloo Wellington 75.8 222 293 70.7 80.8 80.9 237 293 76.2 85.6 77.6 264 340 73.1 82.2 84.6 292 345 80.7 88.6
Hmltn-Ngr-Hldmnd-Brnt 76.7 602 785 73.7 79.7 76.5 679 888 73.6 79.3 78.4 680 867 75.6 81.2 82.9 713 860 80.3 85.5
Central West 73.9 198 268 68.4 79.3 78.7 277 352 74.3 83.1 72.3 297 411 67.8 76.7 76.8 281 366 72.3 81.2
Mississauga Halton 61.3 299 488 56.8 65.7 68.5 442 645 64.9 72.2 70.6 543 769 67.3 73.9 71.1 566 796 67.9 74.3
Toronto Central 70.4 269 382 65.7 75.1 73.9 354 479 69.9 77.9 72.8 338 464 68.7 77.0 72.0 353 490 68.0 76.1
Central 74.8 568 759 71.7 78.0 80.6 689 855 77.9 83.3 82.4 706 857 79.8 85.0 78.7 655 832 75.9 81.6
Central East 75.8 691 912 72.9 78.6 79.9 821 1,027 77.4 82.4 81.7 877 1,073 79.4 84.1 79.1 929 1,174 76.8 81.5
South East 64.3 236 367 59.3 69.3 68.2 223 327 63.0 73.4 79.4 258 325 74.8 83.9 81.6 266 326 77.2 86.0
Champlain 73.3 362 494 69.3 77.3 83.4 466 559 80.2 86.5 82.7 536 648 79.7 85.7 83.7 589 704 80.9 86.5
North Simcoe Muskoka 80.3 237 295 75.6 85.0 84.2 240 285 79.8 88.6 79.6 266 334 75.2 84.1 75.2 243 323 70.4 80.1
North East 75.1 346 461 71.0 79.1 79.9 410 513 76.4 83.5 84.3 419 497 81.0 87.6 86.4 387 448 83.1 89.7
North West 57.7 60 104 47.7 67.7 47.2 51 108 37.3 57.1 56.0 56 100 45.8 66.2 34.4 63 183 27.3 41.6

Report date: November 2017

Data source: ICMS, OHIP CHDB, OCR, RPDB, PCCF+ version 6D

Prepared by: Analytics, Cancer Screening,  P&CC

Note:

  1. Please refer to technical documentation.

Data Table 3. Percentage of Ontario screen-eligible women with an abnormal Ontario Breast Screening Program (OBSP) screening mammogram result, age 50 to 74, who needed a tissue biopsy and were diagnosed within 7 weeks of the abnormal screen date, by age group, 2013 to 2016

Age group Rate (%) in 2013 Numerator in 2013 Denominator in 2013 Lower confidence interval in 2013 Upper confidence interval in 2013 Rate (%) in 2014 Numerator in 2014 Denominator in 2014 Lower confidence interval in 2014 Upper confidence interval in 2014 Rate (%) in 2015 Numerator in 2015 Denominator in 2015 Lower confidence interval in 2015 Upper confidence interval in 2015 Rate (%) in 2016 Numerator in 2016 Denominator in 2016 Lower confidence interval in 2016 Upper confidence interval in 2016 p-value
50 to 74 73.2 4,852 6,625 72.2 74.3 76.9 5,728 7,451 75.9 77.8 79.3 6,229 7,852 78.4 80.2 79.7 6,417 8,051 78.8 80.6
50 to 69 73.0 4,189 5,741 71.8 74.1 76.5 4,982 6,516 75.4 77.5 79.0 5,371 6,796 78.1 80.0 79.3 5,480 6,913 78.3 80.2
50 to 54 69.7 1,210 1,737 67.5 71.9 74.9 1,585 2,116 73.0 76.8 77.5 1,738 2,243 75.7 79.2 77.9 1,679 2,155 76.1 79.7 Ref.
55 to 59 73.0 990 1,356 70.6 75.4 76.9 1,161 1,509 74.8 79.1 79.0 1,184 1,498 76.9 81.1 80.2 1,296 1,616 78.2 82.2 0.089
60 to 64 73.7 980 1,330 71.3 76.1 76.7 1,138 1,484 74.5 78.9 79.8 1,259 1,577 77.8 81.8 79.0 1,275 1,614 77.0 81.0 0.424
65 to 69 76.6 1,009 1,318 74.2 78.9 78.0 1,098 1,407 75.8 80.2 80.5 1,190 1,478 78.5 82.6 80.5 1,230 1,528 78.5 82.5 0.058
70 to 74 75.0 663 884 72.1 77.9 79.8 746 935 77.2 82.4 81.3 858 1,056 78.8 83.7 82.3 937 1,138 80.1 84.6 0.003

Report date: November 2017

Data source: ICMS, OHIP CHDB, OCR, RPDB, PCCF+ version 6D

Prepared by: Analytics, Cancer Screening,  P&CC

Note:

  1. Please refer to technical documentation.

What do the results show?

Follow-up performance within the recommended interval is improving for women who need a tissue biopsy (i.e., the time between an abnormal screen and diagnosis) [1].

  • In 2016, 80% of women who needed a tissue biopsy were diagnosed within 7 weeks of their abnormal mammogram result. Seven-week (with tissue biopsy) follow-up has improved annually since 2013 (when it was 73%), but it still falls below the national target of 90%.
  • There was considerable regional variation for the 7-week (with tissue biopsy) follow-up indicator. The Local Health Integration Networks (LHINs) with the highest 7-week (with tissue biopsy) follow-up for 2016 were Erie St. Clair and South West, which each achieved the national target of 90%. The North West LHIN had the lowest 7-week (with tissue biopsy) follow-up (34%). In 2017, the North West LHIN began a series of initiatives to improve performance for this indicator.
  • Most LHINs improved in 7-week (with tissue biopsy) follow-up performance from 2013 to 2016. From 2013 to 2016, the South East LHIN improved its 7-week (with tissue biopsy) follow-up performance by 18 percentage points, from 64% to 82%. Other LHINs also showed meaningful improvement in performance for this indicator, including Erie St. Clair (16 percentage point improvement) and South West (14 percentage point improvement).

Follow-up is consistent across age groups.

  • Seven-week (with tissue biopsy) follow-up was similar across age groups in 2016. It was lowest in women age 50 to 54 (78%) and highest in women age 70 to 74 (82%). A similar pattern can be seen in previous years.

Why is this important to Ontarians?

Delay between an abnormal screening mammogram and diagnosis can be very stressful for women and may lead to poor outcomes.

  • Psychological distress intensifies as the wait time for diagnosis gets longer [5].
  • The OBSP offers multidisciplinary breast assessment (i.e., diagnostic) services through 70 breast assessment sites (Figure 1).
  • Coordinated diagnostic procedures ensure that a diagnosis is made as effectively as possible. Coordinated diagnosis through OBSP assessment sites allows treatment to begin more quickly, potentially reducing participant anxiety and improving outcomes (e.g., reducing deaths and morbidity) [6].
  • Diagnostic intervals are affected by factors such as human and other resource shortages, including access to imaging and surgical services. Cancer Care Ontario continues to work with relevant partners to find solutions for improving follow-up times.

Organized screening offers several important benefits to women and their healthcare providers.

  • The OBSP and High Risk OBSP provide high-quality screening for most women through the use of mammography, and through mammography and MRIs for women at high risk (or screening breast ultrasound if MRI is not medically appropriate).
  • Quality assurance is ensured through the accreditation of all OBSP sites by the Mammography Accreditation Program of the Canadian Association of Radiologists.
  • Communication to women and healthcare providers includes the following:
    • Women eligible for screening through the OBSP are sent invitations to get screened, along with information about breast cancer screening and details on how to find an OBSP site.
    • After their screening appointment, women with normal screening results get letters telling them their results are normal.
    • Women screened through the OBSP get letters reminding them when to get screened again.
    • OBSP sites follow up on abnormal screening results and send normal and abnormal results to a woman’s healthcare provider.
  • Coordination and navigation includes the following:
    • High Risk OBSP sites arrange genetic assessment (if appropriate) for women referred to the program.
    • High Risk OBSP sites book screening mammography and screening breast MRI (or screening breast ultrasound if MRI is not medically appropriate).
    • The OBSP indicates whether a woman should be screened in 1 year or 2 years based on her screening results and risk factors.
    • OBSP assessment sites help guide women with abnormal screening results to diagnosis by coordinating follow-up tests and documenting the results of those tests.

Next steps

  • Cancer Care Ontario will continue to monitor follow-up of abnormal results and work with regional partners to improve performance.
  • The OBSP continues to expand, with new sites being brought into the program in 2017 and 2018. 

Notes

  1. Canadian Partnership Against Cancer. Report from the evaluation indicators working group: guidelines for monitoring breast cancer screening program performance. 3rd Ed. Toronto: Canadian Partnership Against Cancer; 2013.
  2. Cancer Care Ontario. Ontario cancer screening performance report 2016. Toronto: Cancer Care Ontario; 2016.
  3. Cancer Care Ontario. Breast screening guidelines summary [Internet]. Toronto: Cancer Care Ontario; 2015 [cited 2017 Jan 26]. Available from: here.
  4. Chiarelli AM, Prummel MV, Muradali D, Majpruz V, Horgan M, Carroll JC, et al. Effectiveness of screening with annual magnetic resonance imaging and mammography: results of the initial screening from Ontario high risk breast screening. J Clin Oncol. 2014 Jul 20;32(21):2224–30.
  5. Risberg T, Sorbye SW, Norum J, Wist EA. Diagnostic delay causes more psychological distress in female than in male cancer patients. Anticancer Res. 1996 Mar–Apr;16(2):995–99.
  6. Chiarelli AM, Muradali D, Blackmore KM, Smith CR, Mirea L, Majprux V, et al. Evaluating wait times from screening to breast cancer diagnosis among women undergoing organised assessment vs usual care. Br J Cancer. 2017;116(10):1254–1263.