Breast cancer; The lag time between finding a lump and getting a diagnosis is shrinking. The MUHC now offers a physical, a mammogram, an ultrasound and a biopsy in one day — and wants to do better
By CHARLIE FIDELMAN, The GazetteMay 14, 2009
For Montreal surgeon David Fleiszer, the catalyst was a young woman who faced an agonizing nine-month delay between discovering a lump in her breast and being diagnosed with cancer.
“She was a woman with five young kids and she died a year later,” Fleiszer said. “It just shook me ... the incredible loss. I felt we needed to do better.”
About 10 years ago, the average wait from lump discovery to diagnosis was three months, said Fleiszer, director of the Cedars Breast Clinic of the McGill University Health Centre, where women can have a physical, a mammogram, an ultrasound and a biopsy in the same day.
But even better, Fleiszer said, is the one-day diagnosis plus treatment plan at Toronto’s Princess Margaret Hospital, which has been offered as a pilot project since 2006 to women at the highest risk of having breast cancer.
“I hope they’re setting the new standard that we will catch up to soon. We’re working towards that,” Fleiszer said.
Motivated by his young patient’s death, Fleiszer helped launch the Cedars Breast Clinic.
“We took what was originally a wait time of months and compressed it into a single visit,” he said. “We can still do better but it will take more time and money and effort.”
Quebec has invested $400 million since 2003 in global cancer care but a targeted program similar to Toronto’s would be too difficult, said Marie-Ève Bédard, press attaché to Quebec Health Minister Yves Bolduc.
“It would require a colossal sum of money to mount a fight against just one type of cancer,” Bédard said.
But breast cancer patients and specialists think it would be money well spent.
Breast cancer survivor Rosanne Cohen recalled the day four years ago when she had a routine mammogram at the Cedars clinic, located at the Royal Victoria Hospital: “Suddenly, my life was upside down.”
Cohen had a biopsy within three hours of that mammogram and got the pathology report within two weeks, “so in some ways I was very lucky,” she said.
Any wait time is filled with anxiety, said Cohen, a member of Breast Cancer Action Montreal, an advocacy group.
“One of the really agonizing moments is when they do tests to see how far the cancer has spread. When we know what’s in front of us, most can deal with it. But the unknown factor, that’s extremely terrifying,” she said. “So anything that detracts from that stress is helpful.”
Even once a woman has a diagnosis and a treatment plan she still faces delays: up to four weeks for chemotherapy and 10 weeks for surgery.
Oncologist Gerald Batist, director of the Segal Cancer Centre at the Jewish General Hospital, said the centre is in the process of buying the same machine used in Toronto but that won’t solve all delays.
“This development at the Princess Margaret is precisely what we have planned,” Batist said. “But the machine is only Step 1. The next limitation is availability of trained pathologists to ‘read’ the slides. It’s not just a machine, but trained people, etc. There’s a shortage of pathologists in Quebec.”
As for getting an immediate treatment plan, Batist said he prefers to give the patient and her family about a week to process the diagnosis while his team of specialists discuss options and whether the patient would be eligible for an experimental protocol.
But all Quebec breast cancer centres are working toward the same goal, he added, which is to reduce wait times between an abnormal mammogram or ultrasound to biopsy and diagnosis.
“We do a needle biopsy at the CHUM if there is a high suspicion of cancer,” said André Robidoux, director of the Groupe de recherche en cancer du sein at the Centre hospitalier de l’Université de Montréal.
Toronto’s rapid diagnostic centre opened thanks to a $12.5-million donation from a breast cancer survivor. But the service at Princess Margaret is for patients who have been preselected as the most likely to have cancer. It’s not open to all women, Robidoux noted.
But Quebec’s breast cancer screening program, set up in 1998 for women ages 50-65, guarantees rapid access to testing, diagnosis and a treatment plan, usually within 12 days for those in the program, he said.
Unfortunately, not all women take advantage of it, Robidoux said.
Today, despite awareness campaigns, breast cancer fundraisers and a massive screening program, many women still avoid having a mammogram because they fear the diagnosis, he said.
Conversely, a woman who discovers a lump on her own can face many delays, Robidoux said.
“She’s seen by a doctor, sent for a mammogram, he gets the report, and then tries to find a surgeon. That takes longer and it’s unacceptable,” Robidoux said.
Breast cancer is the most common cancer among Canadian women, according to the Canadian Cancer Society.
About 22,700 women will be diagnosed with breast cancer and 5,400 will die of it this year.
Cedars Breast Clinic: http://bit.ly/x3VfW
Groupe de recherche en cancer du sein: http://grcs-crchum.ca/
Segal Cancer Centre: http://bit.ly/U0JVO