Permanent pacemaker implantation technique: part II

Background: Currently there is no agreement on the optimal time to treatment of breast cancer; however, given the considerable emphasis on early detection, one would expect a similar emphasis on early treatment. The purpose of our study was to assess the time interval to surgery from initiation of diagnosis among Quebec women with breast cancer and to examine the influence on waiting time of age, pattern of care and cancer stage. Methods: Records of physician fee-for-service claims and of hospital admissions were obtained for all Quebec women who underwent an invasive procedure for the diagnosis or treatment of breast cancer between 1992 and 1998. Waiting time was calculated as the number of days between the first diagnostic procedure and surgical treatment. Results: There were 29 606 episodes of breast cancer surgery among 28 100 women: 5922 mastectomies and 23 684 lumpectomies. The absolute number of episodes of breast cancer treated with surgery rose from 3626 in 1992 to 5162 in 1998. The overall median waiting time was 34 days (interquartile range IQR 19–62); 13.5% of the women waited longer than 90 days. The median waiting time rose from 29 days (IQR 15–54) in 1992 to 42 days (IQR 24–72) in 1998, representing a relative increase of 37% (95% confidence interval CI 32%–43%) after adjusting for age and cancer stage. The median waiting time increased with the number of diagnostic procedures, from 24 days (IQR 14–42) with 1 procedure to 48 days (IQR 27–84) with 3 procedures to 72 days (IQR 43–121) with 4 procedures, representing adjusted relative increases of 97% (95% CI 91%–103%) and 194% (95% CI 181%–208%), respectively. The proportion of women receiving 3 or more diagnostic procedures before surgery increased steadily over the study period, from 19.2% in 1992 to 33.0% in 1998. The median waiting time was shorter with more advanced stages of cancer: 53 days (IQR 30–86) for carcinoma in situ, 35 (IQR 20–62) for localized disease, 28 (IQR 16–49) for regional disease and 24 (IQR 11–52) for disseminated disease. Interpretation: Waiting time between initial diagnosis and first surgery for breast cancer has increased substantially in Quebec between 1992 and 1998. Possible explanations include increased demand, decreased resources and changes in patterns of care.