Factors Associated with the Breast Cancer Diagnostic Interval across Five Canadian Provinces: A CanIMPACT Retrospective Cohort Study

Arlinda Ruco; Patti A. Groome; Mary L. McBride; Kathleen M. Decker; Eva Grunfeld; Li Jiang; Cynthia Kendell; Aisha Lofters; Robin Urquhart; Khanh Vu; Marcy Winget

doi:10.3390/cancers15020404

Factors Associated with the Breast Cancer Diagnostic Interval across Five Canadian Provinces: A CanIMPACT Retrospective Cohort Study

Arlinda Ruco, Patti A. Groome, Mary L. McBride, Kathleen M. Decker, Eva Grunfeld, Li Jiang, Cynthia Kendell, Aisha Lofters, Robin Urquhart, Khanh Vu, Marcy Winget

Medicine

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Resumen

The cancer diagnostic process can be protracted, and it is a time of great anxiety for patients. The objective of this study was to examine inter- and intra-provincial variation in diagnostic intervals and explore factors related to the variation. This was a multi-province retrospective cohort study using linked administrative health databases. All females with a diagnosis of histologically confirmed invasive breast cancer in British Columbia (2007–2010), Manitoba (2007–2011), Ontario (2007–2010), Nova Scotia (2007–2012), and Alberta (2004–2010) were included. The start of the diagnostic interval was determined using algorithms specific to whether the patient’s cancer was detected through screening. We used multivariable quantile regression analyses to assess the association between demographic, clinical and healthcare utilization factors with the diagnostic interval outcome. We found significant inter- and intra-provincial variation in the breast cancer diagnostic interval and by screen-detection status; patients who presented symptomatically had longer intervals than screen-detected patients. Interprovincial diagnostic interval variation was 17 and 16 days for screen- and symptom-detected patients, respectively, at the median, and 14 and 41 days, respectively, at the 90th percentile. There was an association of longer diagnostic intervals with increasing comorbid disease in all provinces in non-screen-detected patients but not screen-detected. Longer intervals were observed across most provinces in screen-detected patients living in rural areas. Having a regular primary care provider was not associated with a shorter diagnostic interval. Our results highlight important findings regarding the length of the breast cancer diagnostic interval, its variation within and across provinces, and its association with comorbid disease and rurality. We conclude that diagnostic processes can be context specific, and more attention should be paid to developing tailored processes so that equitable access to a timely diagnosis can be achieved.

Idioma original	English
Número de artículo	404
Publicación	Cancers
Volumen	15
N.º	2
DOI	https://doi.org/10.3390/cancers15020404
Estado	Published - ene. 2023

Nota bibliográfica

Funding Information:
This work was supported by the Canadian Institutes of Health Research [grant #128272]. The opinions, results and conclusions reported in this paper are those of the authors and are independent from the funder.

Funding Information:
The data supporting the conclusions of this article are not available in a public repository, in accordance with provincial government policies. They are housed at Population Data BC (British Columbia), Manitoba Population Research Data Repository (Manitoba), Institute for Clinical Evaluative Sciences (Ontario), and Health Data Nova Scotia (Nova Scotia). Nova Scotia data were provided by Health Data Nova Scotia and the Nova Scotia Department of Health and Wellness (Cancer Care NS and NS Breast Screening Program), however, the observations and opinions expressed are those of the authors and do not represent those of either Health Data Nova Scotia or the Nova Scotia Department of Health and Wellness. Data for this study were also provided by Population Data BC and BC Cancer. All inferences, opinions, and conclusions drawn in this study are those of the authors, and do not reflect the opinions or policies of the BC Data Steward(s). (“BC Cancer Agency Registry Data. V2, Population Data BC: BC Cancer Agency; 2011 [Available from: https://www.popdata.bc.ca/data , (accessed on 4 March 2022)],” n.d.; “Medical Services Plan (MSP) Payment Information File. V2, MOH (2011): British Columbia Ministry of Health; 2011 [Available from: https://www.popdata.bc.ca/data , (accessed on 4 March 2022)],” n.d.; “Consolidation File (MSP Registration & Premium Billing). V2, Population Data BC: British Columbia Ministry of Health (2011); 2011 [Available from: https://www.popdata.bc.ca/data , (accessed on 4 March 2022)],” n.d.). The Ontario data repository for this study was supported by ICES, which is funded by an annual grant from the Ontario Ministry of Health (MOH) and the Ministry of Long-Term Care (MLTC). Parts of this material are based on data and information compiled and provided by Ontario Health (OH) and the Canadian Institute for Health Information (CIHI). The analyses, conclusions, opinions and statements expressed herein are solely those of the authors and do not necessarily reflect those of the data sources; no endorsement is intended or should be inferred. The authors gratefully acknowledge CancerCare Manitoba for their ongoing support and Manitoba Health for the provision of data. The results and conclusions presented are those of the authors. No official endorsement by Manitoba Health is intended or should be inferred. Acknowledgments

Publisher Copyright:
© 2023 by the authors.

ASJC Scopus Subject Areas

Oncology
Cancer Research

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Journal Article

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title = "Factors Associated with the Breast Cancer Diagnostic Interval across Five Canadian Provinces: A CanIMPACT Retrospective Cohort Study",

abstract = "The cancer diagnostic process can be protracted, and it is a time of great anxiety for patients. The objective of this study was to examine inter- and intra-provincial variation in diagnostic intervals and explore factors related to the variation. This was a multi-province retrospective cohort study using linked administrative health databases. All females with a diagnosis of histologically confirmed invasive breast cancer in British Columbia (2007–2010), Manitoba (2007–2011), Ontario (2007–2010), Nova Scotia (2007–2012), and Alberta (2004–2010) were included. The start of the diagnostic interval was determined using algorithms specific to whether the patient{\textquoteright}s cancer was detected through screening. We used multivariable quantile regression analyses to assess the association between demographic, clinical and healthcare utilization factors with the diagnostic interval outcome. We found significant inter- and intra-provincial variation in the breast cancer diagnostic interval and by screen-detection status; patients who presented symptomatically had longer intervals than screen-detected patients. Interprovincial diagnostic interval variation was 17 and 16 days for screen- and symptom-detected patients, respectively, at the median, and 14 and 41 days, respectively, at the 90th percentile. There was an association of longer diagnostic intervals with increasing comorbid disease in all provinces in non-screen-detected patients but not screen-detected. Longer intervals were observed across most provinces in screen-detected patients living in rural areas. Having a regular primary care provider was not associated with a shorter diagnostic interval. Our results highlight important findings regarding the length of the breast cancer diagnostic interval, its variation within and across provinces, and its association with comorbid disease and rurality. We conclude that diagnostic processes can be context specific, and more attention should be paid to developing tailored processes so that equitable access to a timely diagnosis can be achieved.",

author = "Arlinda Ruco and Groome, {Patti A.} and McBride, {Mary L.} and Decker, {Kathleen M.} and Eva Grunfeld and Li Jiang and Cynthia Kendell and Aisha Lofters and Robin Urquhart and Khanh Vu and Marcy Winget",

note = "Funding Information: This work was supported by the Canadian Institutes of Health Research [grant #128272]. The opinions, results and conclusions reported in this paper are those of the authors and are independent from the funder. Funding Information: The data supporting the conclusions of this article are not available in a public repository, in accordance with provincial government policies. They are housed at Population Data BC (British Columbia), Manitoba Population Research Data Repository (Manitoba), Institute for Clinical Evaluative Sciences (Ontario), and Health Data Nova Scotia (Nova Scotia). Nova Scotia data were provided by Health Data Nova Scotia and the Nova Scotia Department of Health and Wellness (Cancer Care NS and NS Breast Screening Program), however, the observations and opinions expressed are those of the authors and do not represent those of either Health Data Nova Scotia or the Nova Scotia Department of Health and Wellness. Data for this study were also provided by Population Data BC and BC Cancer. All inferences, opinions, and conclusions drawn in this study are those of the authors, and do not reflect the opinions or policies of the BC Data Steward(s). (“BC Cancer Agency Registry Data. V2, Population Data BC: BC Cancer Agency; 2011 [Available from: https://www.popdata.bc.ca/data , (accessed on 4 March 2022)],” n.d.; “Medical Services Plan (MSP) Payment Information File. V2, MOH (2011): British Columbia Ministry of Health; 2011 [Available from: https://www.popdata.bc.ca/data , (accessed on 4 March 2022)],” n.d.; “Consolidation File (MSP Registration & Premium Billing). V2, Population Data BC: British Columbia Ministry of Health (2011); 2011 [Available from: https://www.popdata.bc.ca/data , (accessed on 4 March 2022)],” n.d.). The Ontario data repository for this study was supported by ICES, which is funded by an annual grant from the Ontario Ministry of Health (MOH) and the Ministry of Long-Term Care (MLTC). Parts of this material are based on data and information compiled and provided by Ontario Health (OH) and the Canadian Institute for Health Information (CIHI). The analyses, conclusions, opinions and statements expressed herein are solely those of the authors and do not necessarily reflect those of the data sources; no endorsement is intended or should be inferred. The authors gratefully acknowledge CancerCare Manitoba for their ongoing support and Manitoba Health for the provision of data. The results and conclusions presented are those of the authors. No official endorsement by Manitoba Health is intended or should be inferred. Acknowledgments Publisher Copyright: {\textcopyright} 2023 by the authors.",

year = "2023",

month = jan,

doi = "10.3390/cancers15020404",

language = "English",

volume = "15",

journal = "Cancers",

issn = "2072-6694",

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T2 - A CanIMPACT Retrospective Cohort Study

AU - Ruco, Arlinda

AU - Groome, Patti A.

AU - McBride, Mary L.

AU - Decker, Kathleen M.

AU - Grunfeld, Eva

AU - Jiang, Li

AU - Kendell, Cynthia

AU - Lofters, Aisha

AU - Urquhart, Robin

AU - Vu, Khanh

AU - Winget, Marcy

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Y1 - 2023/1

N2 - The cancer diagnostic process can be protracted, and it is a time of great anxiety for patients. The objective of this study was to examine inter- and intra-provincial variation in diagnostic intervals and explore factors related to the variation. This was a multi-province retrospective cohort study using linked administrative health databases. All females with a diagnosis of histologically confirmed invasive breast cancer in British Columbia (2007–2010), Manitoba (2007–2011), Ontario (2007–2010), Nova Scotia (2007–2012), and Alberta (2004–2010) were included. The start of the diagnostic interval was determined using algorithms specific to whether the patient’s cancer was detected through screening. We used multivariable quantile regression analyses to assess the association between demographic, clinical and healthcare utilization factors with the diagnostic interval outcome. We found significant inter- and intra-provincial variation in the breast cancer diagnostic interval and by screen-detection status; patients who presented symptomatically had longer intervals than screen-detected patients. Interprovincial diagnostic interval variation was 17 and 16 days for screen- and symptom-detected patients, respectively, at the median, and 14 and 41 days, respectively, at the 90th percentile. There was an association of longer diagnostic intervals with increasing comorbid disease in all provinces in non-screen-detected patients but not screen-detected. Longer intervals were observed across most provinces in screen-detected patients living in rural areas. Having a regular primary care provider was not associated with a shorter diagnostic interval. Our results highlight important findings regarding the length of the breast cancer diagnostic interval, its variation within and across provinces, and its association with comorbid disease and rurality. We conclude that diagnostic processes can be context specific, and more attention should be paid to developing tailored processes so that equitable access to a timely diagnosis can be achieved.

AB - The cancer diagnostic process can be protracted, and it is a time of great anxiety for patients. The objective of this study was to examine inter- and intra-provincial variation in diagnostic intervals and explore factors related to the variation. This was a multi-province retrospective cohort study using linked administrative health databases. All females with a diagnosis of histologically confirmed invasive breast cancer in British Columbia (2007–2010), Manitoba (2007–2011), Ontario (2007–2010), Nova Scotia (2007–2012), and Alberta (2004–2010) were included. The start of the diagnostic interval was determined using algorithms specific to whether the patient’s cancer was detected through screening. We used multivariable quantile regression analyses to assess the association between demographic, clinical and healthcare utilization factors with the diagnostic interval outcome. We found significant inter- and intra-provincial variation in the breast cancer diagnostic interval and by screen-detection status; patients who presented symptomatically had longer intervals than screen-detected patients. Interprovincial diagnostic interval variation was 17 and 16 days for screen- and symptom-detected patients, respectively, at the median, and 14 and 41 days, respectively, at the 90th percentile. There was an association of longer diagnostic intervals with increasing comorbid disease in all provinces in non-screen-detected patients but not screen-detected. Longer intervals were observed across most provinces in screen-detected patients living in rural areas. Having a regular primary care provider was not associated with a shorter diagnostic interval. Our results highlight important findings regarding the length of the breast cancer diagnostic interval, its variation within and across provinces, and its association with comorbid disease and rurality. We conclude that diagnostic processes can be context specific, and more attention should be paid to developing tailored processes so that equitable access to a timely diagnosis can be achieved.

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Factors Associated with the Breast Cancer Diagnostic Interval across Five Canadian Provinces: A CanIMPACT Retrospective Cohort Study

Resumen

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PubMed: MeSH publication types

ODS de las Naciones Unidas

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