Innovation fast-tracks breast cancer diagnosis

Few things cause more anxiety for women than finding a lump in their breast. The discovery is the beginning of what is often a lengthy and emotionally stressful journey to diagnosis.

In British Columbia, patients at risk of breast cancer currently require many separate visits to different health-care providers at different locations at each stage of the diagnostic and treatment pathway, often creating unnecessary gaps and delays in care. Some Greater Vancouver patients have experienced waits of up to two months to confirm or rule out breast cancer.

Providence Health Care’s new Rapid Access Breast Clinic at Mount Saint Joseph (MSJ) Hospital in Vancouver is changing this by cutting down wait time to diagnosis and catching breast cancer more quickly. Opened in May 2009, the Rapid Access Breast Clinic is B.C.’s first comprehensive breast cancer diagnostic clinic of its kind. It has adopted European best practices by following EUSOMA (European Society of Mastology) standards of care.

All diagnostic testing is coordinated and organized in a streamlined manner under one roof. The target is to provide a diagnosis within 21 calendar days (the European standard).

The clinic’s “one-stop shop” approach eliminates the need for numerous appointments and tests at different locations. The convenience and quick turnaround to diagnosis are popular with patients. “Waiting is one of the worst parts of hearing that you may have breast cancer,” says 40-year old Lynda Cho, a breast cancer patient at the MSJ clinic. The shortened time to diagnosis alleviated her stress during what was a very “nerve-wracking experience.”

Meeting the targets returns the clinic a different sort of benefit. Under a “pay-for-performance” system, for each patient the clinic diagnoses within the 21 calendar day target, the clinic receives $400 through the BC Ministry of Health Services’ Lower Mainland Innovation and Integration Fund (LMIIF). The LMIIF resources – earmarked at $1.25 million for the MSJ Rapid Access Breast Clinic – will allow the clinic to diagnose up to 3,000 patients annually.

Within the clinic, the multidisciplinary team – comprised of breast surgeons, breast radiologists, a nurse navigator, a nurse practitioner and a general practitioner – conducts a “triple assessment” for each patient. This consists of a diagnostic digital mammogram (MSJ’s clinic is the only clinic in Metro Vancouver using this technology) and/or diagnostic ultrasound, followed by a physical examination by a breast specialist, and then an ultrasound-guided or stereotactic core biopsy.

The nurse navigator acts as the single point of contact for patients, providing a link between them and the clinic’s team of health-care professionals to provide a streamlined and seamless journey through the complex health-care system. The nurse navigator not only provides health information, but also support as emotional emergencies often occur once a patient has learned they have a breast abnormality. At this time, the nurse navigator’s role is vital in helping patients to clearly comprehend each of the steps within their unique diagnostic plan. The clinic currently has the only patient navigation system for breast cancer diagnosis in B.C.

If the diagnosis is positive, the clinic prepares a co-ordinated care plan, organizes further diagnostics (such as breast MRI), medical oncology consults, radiation oncology consults, BC Cancer Agency consults and referrals for other breast services (such as radiation and chemotherapy), avoiding the need for the patient to go back to their primary care physician for referrals. The clinic also provides direct referrals to MSJ’s breast reconstruction program, providing immediate or post-surgical breast reconstruction by a plastic surgeon.

These additional features help foster a more positive experience and relationship patients have with their health care providers. “As a busy mom of two kids, it was especially convenient having everything done in one place, from my mammogram to receiving my diagnosis to surgery, and very comforting to deal with only one health care team,” says Cho.

“This innovative approach is already paying dividends,” says Dr. Urve Kuusk, medical director of MSJ’s clinic and breast surgeon. “With our streamlined process, all tests and exams are done on site, with a core team of multidisciplinary staff working together to carefully follow the patient. Everyone wins – the patients don’t fall through the cracks, we eliminate duplication of services and multiple visits and we can ensure all aspects of the patient’s diagnostic journey are addressed.”

So far, the results of MSJ’s clinic are extremely promising. Since the clinic’s opening in May, the majority of patients complete all of the necessary radiology tests within three to five days of referral. Furthermore, the clinic has been successful in providing patients with their cancer diagnosis within an average of ten days of being referred. To date, a total of 749 patients have been treated and more than 1,312 diagnostic tests performed.