Warning sounded over waits for cancer treatment in Quebec

Although there is currently no agreement on what the optimal time to treatment should be, practice guidelines for breast cancer emphasize that the work-up of a lump in the breast should be completed as soon as possible after detection.

To assess the time interval from diagnosis to surgery, Dr. Nancy Mayo and colleagues examined physician fee-for-service claims and hospital admissions for all Quebec women who underwent an invasive procedure for the diagnosis or treatment of breast cancer between 1993 and 1998.

The authors found a significant increase over the 6-year period in waiting time between initial diagnosis and first surgery. The number of episodes of breast cancer surgery rose from 3626 in 1992 to 5162 in 1998, and the median waiting time rose from 29 days to 42 days respectively. The proportion of episodes in which women underwent 3 or more diagnostic procedures before surgery increased from 19.2% in 1992 to 33.0% in 1998, and as the number of procedures increased, so did the wait.

�At this time, the data from our study provide information on expected delays and serve to warn us that rapid cuts in health care spending, if they are not accompanied by an effective planning process, may produce undesirable effects in service delivery,� the authors conclude.

Journalists' note: This is the first article to receive �fast-track� status from CMAJ. Under this process, editorial review of articles, including peer review, is speeded up so that important results can be reported more quickly. An explanation of the process is provided in an editorial appearing in this issue.

Waiting time for breast cancer surgery in Quebec

� N.E. Mayo et., al.