A new analysis by the Ontario Medical Association shows about 422,000 fewer mammograms happened during the pandemic than forecasted. Because of missed screenings, patients are showing up sicker and later, with cancer that is more advanced.
“Screenings have returned to forecasted levels, but many women still haven’t had a mammogram since before March 2020,” said OMA President Dr. Rose Zacharias during the Ask Ontario Doctors: How the Pandemic Impacted Breast Cancer media briefing on Oct. 12. “Experts worry that means there are undiagnosed cases of breast cancer yet to show up.”
October is Breast Cancer Awareness Month. One in eight Canadian women can expect to be diagnosed with breast cancer in their lifetime. Finding cancer early means it's less likely that the cancer has spread and treatment can start sooner.
Dr. Jean Seely, a radiologist and head of the Breast Imaging Section at The Ottawa Hospital, said that before the pandemic, about half of breast cancers diagnosed at the Ottawa Hospital were found through screening. During the pandemic, this number dropped to less than one third, meaning 71 per cent of women were diagnosed because they had symptoms of breast cancer such as a lump.
“This means that cancers were more advanced at diagnosis,” said Dr. Seely. “The delays in screening for breast cancer due to the pandemic are leading to poorer outcomes for our patients, which is affecting their long-term survival.”
When breast cancer is diagnosed at stage 0 or 1, the five-year survival is 98 per cent. When diagnosed at stage 4, meaning it has already spread to the other parts of the body, the five-year survival is only 22 to 39 per cent.
The pandemic has caused strain across the health-care system and resulted in longer wait times from diagnosis all the way through to surgery.
Dr. Erin Cordeiro, a breast surgical oncologist at The Ottawa Hospital and medical director of its Breast Health Centre, said wait times for breast cancer surgeries are longer than before the pandemic due to a decrease in operating time and operating room resources.
“Mostly this is due to a shortage of health-care personnel,” said Dr. Cordeiro. “Similar to how restaurants are having difficulties with servers. We’re having difficulties with human health resources within the hospital system.”
The wait time for many breast cancer surgeries is four to six weeks. For reconstruction surgeries, it’s more than a year.
“This time waiting for testing and surgery is obviously incredibly stressful for patients and their families,” she said.
According to research done at Queen’s University and published in the British Medical Journal, every month’s delay in cancer treatment can raise the risk of death by around 10 per cent.
“These findings are all the more important because they reflect larger patterns in the cancer system in Ontario,” said Dr. Timothy Hanna, a radiation oncologist and associate professor at Queen’s University Cancer Research Institute’s Division of Cancer Care and Epidemiology.
Wait times for the treatment of other kinds of cancer have also gotten longer due to the pandemic.
“This is certainly a system-wide issue whose consequences are now emerging and certainly requires action,” said Dr. Hanna.
When a patient is fighting cancer, early detection and treatment save lives, Dr. Zacharias emphasized. This shows the urgent need to tackle the pandemic backlog of care and then fix wait times, which were already longer than recommended for some procedures. Ontario’s doctors have solutions outlined in the Prescription for Ontario: Doctors’ 5-Point Plan for Better Health Care.
The OMA wants to move ahead urgently with the creation of Integrated Ambulatory Centers for less complicated outpatient surgeries and procedures, she said.
“This could ease the burden on hospitals and reduce wait times for the women we've been talking about today. Every number represents a woman and her story.”